This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees (...) of objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts (...) of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the (...) “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

A common epistemological assumption in contemporary bioethics held b y both proponents and critics of non-traditional forms of cognitive enhancement is that cognitive enhancement aims at the facilitation of the accumulation of human knowledge. This paper does three central things. First, drawing from recent work in epistemology, a rival account of cognitive enhancement, framed in terms of the notion of cognitive achievement rather than knowledge, is proposed. Second, we outline and respond to an axiological objection to our proposal that (...) draws from recent work by Leon Kass (2004), Michael Sandel (2009), and John Harris (2011) to the effect that ‘enhanced’ cognitive achievements are (by effectively removing obstacles to success) not worthy of pursuit, or are otherwise ‘trivial’. Third, we show how the cognitive achievement account of cognitive enhancement proposed here fits snugly with recent active externalist approaches (e.g., extended cognition) in the philosophy of mind and cognitive science. (shrink)

The first part of a symposium devoted to Alex Broadbent's essay titled ‘Prediction, Understanding and Medicine’, this article notes the under-development of a variety of issues in the philosophy of medicine that transcend bioethics and the long-standing debates about the nature of health/illness and of evidence-based medicine. It also indicates the importance of drawing on non-Western, and particularly African, traditions in addressing these largely metaphysical and epistemological matters.

In this article, we discuss epistemological limitations relating to the use of ethnoracial categories in biomedical research as devised by the Office of Management and Budget’s institutional guidelines. We argue that the obligation to use ethnoracial categories in genomics research should be abandoned. First, we outline how conceptual imprecision in the definition of ethnoracial categories can generate epistemic uncertainty in medical research and practice. Second, we focus on the use of ethnoracial categories in medical genetics, particularly genomics-based precision medicine, (...) where ethnoracial identity is understood as a proxy for medically relevant differences among individuals. Notably, extensive criticisms have been made already against the genetic interpretation of races, but, nonetheless, the concept of race remains a key element of contemporary genomics. This motivates us to explore possible reasons why such criticisms may have been ineffective in redirecting attention to other (non-race-based) ways of controlling for human variability. We contend that popular arguments against the idea that human races have a genetic basis, though convincing in many respects, are not sufficient to exclude the pragmatic use of race and ethnicity as proxies for genetic variability related to complex phenotypes. Finally, we provide two further arguments to support the idea that ethnoracial categories are unlikely to provide meaningful insights into medical genetics, which implies that even the interpretation of race as a useful tool to stratify disease risk is unwarranted. (shrink)

About the analogy between the epistemological and methodological aspects of the activity of intelligence agencies and some scientific disciplines, advocating for a more scientific approach to the process of collecting and analyzing information within the intelligence cycle. I assert that the theoretical, ontological and epistemological aspects of the activity of many intelligence agencies are underestimated, leading to incomplete understanding of current phenomena and confusion in inter-institutional collaboration. After a brief Introduction, which includes a history of the evolution of the intelligence (...) concept after World War II, Intelligence Activity defines the objectives and organization of intelligence agencies, the core model of these organizations (the intelligence cycle), and the relevant aspects of the intelligence gathering and intelligence analysis. In the Ontology section, I highlight the ontological aspects and the entities that threaten and are threatened. The Epistemology section includes aspects specific to intelligence activity, with the analysis of the traditional (Singer) model, and a possible epistemological approach through the concept of tacit knowledge developed by scientist Michael Polanyi. In the Methodology section there are various methodological theories with an emphasis on structural analytical techniques, and some analogies with science, archeology, business and medicine. In Conclusions I argue on the possibility of a more scientific approach to methods of intelligence gathering and analysis of intelligence agencies. -/- ISBN 978-606-033-219-0, DOI: 10.58679/MM58823. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that the (...) practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

In this paper, I open an inquiry that provides a catalyst for the inauguration of African Philosophy of Medicine and Bioethics (APMB) as a full-fledged academic pursuit. I situate this inquiry within the quest of early professional African philosophers for a stirring of the course of contemporary African philosophy along the path of critically retrieving, clarifying, and articulating aspects of traditional African culture and practices in the light of social pluralism and modernization. The case I make for the establishment (...) of this discipline and my effort to delineate its nature, scope, and method hinge on three important realities: (i) The existence of African Traditional Medicine (ATM); (ii) the existence of philosophical puzzles in ATM that require conceptual, metaphysical, epistemological, ethical, and socio-political analyses; and (iii) the need to carry out this analysis in the context of the twenty-first-century reality of medical pluralism and globalization. Solidifying my effort to map out the landscape of this new enterprise, in the concluding part of this paper, I make recommendations on the direction the discipline is to take if it must fulfil its goal of providing a framework for the improvement of medical knowledge and practice in contemporary Africa. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

This paper addresses the recent rise of the use of alternative medicine in Western countries. It offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical modalities. The explanatory (...) theory defended here is then predicated on the idea that an extreme patient-centric model of medical practice that treats largely ignorant patients as consumers of medical products and services endowed with an essentially unrestricted power of freedom to choose treatments predictably leads serious and avoidable harms. Some important moral and epistemological consequences of this model are then articulated and corrective measures are suggested. (shrink)

Positivist medical historians, guided by the savoir of modern western biomedicine, have long depicted medieval medicine as an aberration along the continuum of scientific and medical progress. Historical epistemology, founded in the ideas of Cavailles, Foucault, Davidson, and Hacking, however, allows the historian to disrupt this false continuum and to unchain medieval medicine from modern medicine. Postmodernist approaches, such as those sourced in Lyotard, Barthes, and Derrida, allow the historian to further deconstruct medieval and modern medical (...) discourse, revealing a multitude of narrative lenses spinning around biomedical and biocultural strands. In liberating these two medical systems and setting them within the distinct historical and epistemological contexts that both shaped and were shaped by them, the historian can revision the theories, practices, and culture of medieval medicine without having to anachronistically justify them according to modern medical discourse. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether (...) the functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...) conducted with gravitational wave physicists. I show that considerations about time and speed play a role in every stage of research: goal setting, method design, and the evaluation and communication of results. Part II provides a case study on translational medicine, an approach explicitly dedicated to accelerating research in order to develop and implement new therapies. This epitomizes applied research with high social stakes, motivated by non-epistemic goals. Here, epistemic trade-offs between speed and reliability intersect with ethical trade-offs between different types of harms. In Part III, the insights from both of these case studies are used as the basis for a more general discussion concerning the pragmatic aspects of epistemic practices, especially in relation to current debates centered on the role of values in science. A particular focus is on the value of speed and the ability to generate reliable results, either via choice of methods, or via decisions about which goals to set, as well as decisions about when to stop further testing. The primary thesis of the dissertation is that pragmatic considerations stemming from limitations of resources are a necessary feature of the pursuit of epistemic aims, and that the epistemic is thus inherently pragmatic. (shrink)

Evidence-based medicine (EBM) calls for medical practitioners to “integrate” our best available evidence into clinical practice. A significant amount of the literature on EBM takes this integration to be unproblematic, focusing on questions like how to interpret evidence and engage with patient values, rather than critically looking at how these features of EBM can be implemented together. Other authors have also commented on this gap in the literature, for example, identifying the lack of clarity about how patient preferences and (...) evidence from trials is supposed to be integrated in practice. In this paper, I look at this issue from an epistemological perspective, (looking at how different types of knowledge in EBM can be used to make sounds judgements). In particular, I introduce an epistemological issue for this integration problem, which I call the epistemic integration problem. This is essentially the problem of how we can use information that is both general (eg, about a population sample) and descriptive (eg, about what expected outcomes are) to reach clinical judgements that are individualized (applying to a particular patient) and normative (about what is best for their health). (shrink)

There is a lot of conceptual engineering going on in medical research. I substantiate this claim with two examples, the medical debate about cancer classification and about obesity as a disease I also argue that the proper target of conceptual engineering in medical research are experts’ conceptions. These are explicitly written down in documents and guidelines, and they bear on research and policies. In the second part of the chapter, I propose an externalist framework in which conceptions have both the (...) explanatory power of psychological concepts and that of semantic concepts. It is likely, however, that human activities and practices distinct from medical research, and regulated by different practices and epistemic rules, call for different targets for conceptual engineering. I conclude with indicating an open agenda of problems for philosophers of medicine interested in conceptual engineering. (shrink)

Philosophy of immunology is a subfield of philosophy of biology dealing with ontological and epistemological issues related to the studies of the immune system. While speculative investigations and abstract analyses have always been part of immune theorizing, until recently philosophers have largely ignored immunology. Yet the implications for understanding the philosophical basis of organismal functions framed by immunity offer new perspectives on fundamental questions of biology and medicine. Developed in the context of history of medicine, theoretical biology, and (...) medical anthropology, philosophy of immunology differs from these related branches of study in its focus on traditional philosophical questions concerning identity, individuality, ecology, cognition, scientific methodology and theory construction. This broad agenda derives from immunology’s multifaceted research program that has developed from its initial clinical challenges of host defense, transplantation, autoimmunity, tumor immunology, and allergy. In addition to these well-established research areas, immunity is now understood to play a central role in other physiological functions, development, ecology, and evolutionary mechanics. Holding together these diverse domains of inquiry lie philosophical commitments oriented by organismal identity. In this regard, pertinent issues are raised concerning cognition (organization of immune perception and information processing), the character of individuality (framed by the ecological context of immune-mediated assimilation and rejection), and the dynamics of complex systems (understood as holistic systems biology). Indeed, immunology, in the context of cognitive science, evolutionary biology, environmental sciences, and development provides multi-focal perspectives for philosophy of science. (shrink)

This article explores Galen's analysis of and response to the Rationalist and Empiricist medical sects. It argues that his interest in their debate concerning the epistemology of medicine and anatomy was key to his advancement of an experimental methodology.

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist (...) view that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do not (...) subscribe to feminist science studies’ normative program——where contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework. -/- See response by Sharyn Clough: http://wp.me/p1Bfg0-1aN See reply by Maya Goldenberg: http://wp.me/p1Bfg0-1oY. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a better position (...) to make sense of them both as natural phenomena. (shrink)

Fears of black-box algorithms are multiplying. Black-box algorithms are said to prevent accountability, make it harder to detect bias and so on. Some fears concern the epistemology of black-box algorithms in medicine and the ethical implications of that epistemology. Durán and Jongsma (2021) have recently sought to allay such fears. While some of their arguments are compelling, we still see reasons for fear.

Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the culprit (...) of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal. -/- . (shrink)

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of the (...) 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. Next, I review several of the problems that have been identified as resulting from a staunch commitment to empiricism in medical practice. Finally, I conclude that greater epistemological awareness in the medical community would precipitate a Galenic shift toward a more epistemically balanced, scientific approach to clinical research. (shrink)

What is W. V. O. Quine’s relationship to classical pragmatism? Although he resists the comparison to William James in particular, commentators have seen an affinity between his “web of belief” model of theory confirmation and James’s claim that our beliefs form a “stock” that faces new experience as a corporate body. I argue that the similarity is only superficial. James thinks our web of beliefs should be responsive not just to perceptual but also to emotional experiences in some cases; Quine (...) denies this. I motivate James’s controversial view by appealing to an episode in the history of medicine when a researcher self-experimented by swallowing a vial of bacteria that at the time had not been studied in much detail. The researcher’s commitment to his own as-yet untested hypothesis was based in part on emotional considerations. Finally, I argue that Quine’s insistence that emotions can never be relevant to adjusting our web of belief reflects a tacit holdover of one of logical positivism’s crucially anti-pragmatist commitments—that philosophy of science should focus exclusively on the context of justification, not the context of discovery. James’s emphasis on discovery as a (perhaps the) crucial locus for epistemological inquiry is characteristic of pragmatism in general. Since Quinean epistemology is always an epistemology of justification, he is not happily viewed as a member of the pragmatist tradition. (shrink)

Alison Bailey’s The Weight of Whiteness: A Feminist Engagement with Privilege, Race, and Ignorance examines how whiteness misshapes our humanity, measuring the weight of whiteness in terms of its costs and losses to collective humanity. People of color feel the weight of whiteness daily. The resistant habits of whiteness and its attendant privileges, however, make it difficult for white people to feel the damage. White people are more comfortable thinking about white supremacy in terms of what privilege does for them, (...) rather than feeling what it does to them. The first half of the book focuses on the overexposed side of white privilege, the side that works to make the invisible and intangible structures of power more visible and tangible. Bailey discusses the importance of understanding privileges intersectionally, the ignorance-preserving habits of “white talk,” and how privilege and ignorance circulate in educational settings. The second part invites white readers to explore the underexposed side of white dominance, the weightless side that they would rather not feel. The final chapters are powerfully autobiographical. Bailey engages readers with a deeply personal account of what it means to hold space with the painful weight of whiteness in her own life. She also offers a moving account of medicinal genealogies, which helps to engage the weight she inherits from her settler colonial ancestors. The book illustrates how the gravitational pull of white ignorance and comfort are stronger than the clean pain required for collective liberation. The stakes are high: Failure to hold the weight of whiteness ensures that white people will continue to blow the weight of historical trauma through communities of color. -/- All rights reserved. No portion of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. -/- -/- . (shrink)

I provide a critical review of Moti Mizrahi's The Relativity of Theory, expounding on the book's strengths and then providing an extended argument that Mizrahi mischaracterizes the epistemic attitude of concern to antirealism about science as well as the practical stakes involved in adopting the antirealist position.

Cancer biology features the ascription of normal functions to parts of cancers. At least some ascriptions of function in cancer biology track local normality of parts within the global abnormality of the aberration to which those parts belong. That is, cancer biologists identify as functions activities that, in some sense, parts of cancers are supposed to perform, despite cancers themselves having no purpose. The present paper provides a theory to accommodate these normal function ascriptions—I call it the Modeling Account of (...) Normal Function (MA). MA comprises two claims. First, normal functions are activities whose performance by the function-bearing part contributes to the self-maintenance of the whole system and, thereby, results in the continued presence of that part. Second, MA holds that models of system-level activities that are (partly) constitutive of self-maintenance are improved by including a representation of the relevant function-bearing part and by making reference to the activity/activities that part performs which contribute(s) to those system-level activities. I contrast MA with two other accounts that seek to explicate the ascription of normal functions in biology, namely, the organizational account and the selected effects account. Both struggle to extend to cancer biology. However, I offer ecumenical readings which allow them to recover some ascriptions of normal function to parts of cancers. So, though I contend that MA excels in this respect, the purpose of this paper is served if it provides materials for bridging the gap between cancer biology, philosophy of cancer, and the literature on function. (shrink)

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the (...) connections between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink)

In spite of a considerable progress in comorbidity research and huge literature on it, this phenomenon is one of the greatest epistemological, research and clinical challenges to contemporary psychiatry and medicine. Mental disorders are very often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Therefore, comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and effi cient treatment (...) within the frame of person centered transdisciplinary psychiatry and integrative medicine. This review focuses fi rst on conceptual chaos and different connotations, then on transdisciplinary perspectives of comorbidity and multimorbidity. The authors compiled an extensive set of various views and perspectives, dilemmas and controversies, in order to evaluate what we know and what we don’t about comorbidity, what comorbidity is and what comorbidity is not, what are facts and what are non-facts on comorbidity and multimorbidity. (shrink)

With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The (...) worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that non-epistemic values can be rationally evaluated and that standpoint epistemology’s universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding, I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. I further argue that my recommended empiricist methodology is preferable to Psillos’s search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science. (shrink)

Disagreement among experts is a central topic in social epistemology. What should an expert do when confronted with the different opinion of an epistemic peer? Possible answers include the steadfast view (holding to one’s belief), the abstemious view (suspending one’s judgment), and moderate conciliatory views, which specify criteria for belief change when a peer’s different opinion is encountered. The practice of Delphi techniques in healthcare, medicine, and social sciences provides a real-life case study of expert disagreement, where disagreement (...) is gradually transformed into consensus. An analysis of Delphi shows that moderate conciliatory views are descriptively more adequate than rival views. However, it also casts doubt on whether the debate in social epistemology is explanatory relevant vis-à-vis real life cases of expert disagreement, where consensus replaces truth, and acceptance is more explanatorily relevant than belief. (shrink)

Under the traditional system of peer-reviewed publication, the degree of prestige conferred to authors by successful publication is tied to the degree of the intellectual rigor of its peer review process: ambitious scientists do well professionally by doing well epistemically. As a result, we should expect journal editors, in their dual role as epistemic evaluators and prestige-allocators, to have the power to motivate improved author behavior through the tightening of publication requirements. Contrary to this expectation, I will argue that the (...) publication bias literature in academic medicine demonstrates that editor interventions have had limited effectiveness in improving the health of the publication and trial registration record, suggesting that much stronger interventions are needed. (shrink)

Biomarkers are widely used not only as prognostic or diagnostic indicators, or as surrogate markers of disease in clinical trials, but also to formulate theories of pathogenesis. We identify two problems in the use of biomarkers in mechanistic studies. The first problem arises in the case of multifactorial diseases, where different combinations of multiple causes result in patient heterogeneity. The second problem arises when a pathogenic mediator is difficult to measure. This is the case of the oxidative stress (OS) theory (...) of disease, where the causal components are reactive oxygen species (ROS) that have very short half-lives. In this case, it is usual to measure the traces left by the reaction of ROS with biological molecules, rather than the ROS themselves. Borrowing from the philosophical theories of signs, we look at the different facets of biomarkers and discuss their different value and meaning in multifactorial diseases and system medicine to inform their use in patient stratification in personalized medicine. (shrink)

Aristotle classifies opposition (ἀντικεῖσθαι) into four groups: relatives (τὰ πρός τι), contraries (τὰ ἐναντία), privation and possession (στρέσις καὶ ἓξις) and affirmation and negation (κατάφασις καὶ ἀπόφασις). (Cat. , 10, 11b15-23) His example of relatives are the double and the half. Aristotle’s description of relatives as a kind of opposition is as such: ‘Things opposed as relatives are called just what they are, of their opposites (αὐτὰ ἃπερ ἐστι τῶν ἀντικειμένων λέγεται) or in some other way in relation to them. (...) For example, the double is called just what it is double of the other (οἷον τὸ διπλάσιον, αὐτὸ ὃπερ ἐστίν, ἑτέρου διπλάσιον λέγεται). Again, knowledge and the knowable are opposed as relatives, and knowledge is called just what it is, of the knowable, and the knowable too is called just what it is, in relation to its opposite, knowledge; for the knowable is called knowable by something-by knowledge.’ (Cat., 10, 11b24-30) 2) Senses of relatives In Met., Δ, 1020b26-32 Aristotle distinguishes three senses of relatives: i) That which contains something else many times to that which is contained many times in something else, and that which exceeds to that which is exceeded. E.g. double to half ii) The active to the passive; e.g. that which can heat to that which can be heated iii) The measurable to the measure, e.g. the knowable to knowledge and the perceptible to perception. 3) Relatives and contraries Aristotle’s discussion of relatives is unbelievably ambiguous. While he enumerates relatives besides contraries, privation-possession and affirmation-negation as four types of opposition (Cat., 10, 11b15-23), not only does not he restrict relatives to oppositions but he also does not totally differentiate it from contraries. Aristotle distinguishes between two senses of relatives one of which is contraries: ‘We have distinguished elsewhere the two senses in which relatives are so called-some as contraries (ὡς ἐναντία), others as knowledge to things known, a term being called relative because what is said one to the other is said by the other to itself (τῷ λέγεσθαί τι ἄλλο πρὸς αὐτό). (Met., I, 1056b34-1057a1) It seems that this differentiation is the same as, and maybe the one he himself refers to, the differentiation between the second and the third senses of relatives in Met., Δ, 1021a27-32: ‘Relative terms which imply number or capacity, therefore, are all relative because their very essence includes in its nature a reference to something else, not because something else is related to it (πρός τι πὰντα ἐστὶ πρός τι τῷ ὃπερ ἐστὶν ἄλλου λέγεσθαι αὐτὸ ὃ ἐστιν, ἀλλὰ μὴ τῷ ἄλλο πρὸς ἐκεινο); but that which is measurable or knowable or thinkable is called relative because something else is related to it. For the thinkable implies that there is thought of it, but the thought is not relative to that of which it is the thought; for we should then have said the same thing twice.’ Although Aristotle confirms contrariety in relatives (e.g. virtue to vice and knowledge to ignorance), he denies that there is a contrary ‘to every relative’ as there can be no contrary to what is double or treble. (Cat., 7, 6b15-19) The fact that Aristotle dedicates one sense of relatives to contraries means that the fourfold division of oppositions is not such a strict division without any kind of community between them. In his example of the first sense, however, Aristotle says: ‘One and number are in a sense opposed, not as contrary, but as we have said some relative terms are opposed; for inasmuch as one is measure and the other measurable, they are opposed.’ (Met., I, 1057a4-6) Now, the question is: Is Aristotle’s first sense of relative a contrary or not? Aristotle tells us that the opposition in this sense of relatives is the opposition of measure and measurable. The second sense has two differences with the first one: i) it is not a contrary and ii) what is said by one of the relatives to the other is also said by the latter to the former. To differentiate it from the first sense, when the one is the measure of the other, the latter will be the measure of the former as well: ‘But though knowledge is similarly spoken of as related to the knowable, the relation does not work out similarly for while knowledge might be thought to be the measure, and the knowable the thing measured, the fact is that all knowledge is knowable, but not all that is knowable is knowledge, because in a sense knowledge is measured by the knowable.’ (Met., I, 1057a7-12) Aristotle’s assertion at Met., I, 1057a36-37 that ‘of relative terms, those which are not contrary have no intermediate’ ensures us that we must take the first sense as contraries. Here he mentions a criterion of differentiation between two senses: while the first sense accepts intermediates (as, for example, great and small do), the second one does not. (Met., I, 1057a37-b1) It seems, however, that it is only the second sense that is the essential sense of relatives because the first sense, Aristotle says, is an accidental sense: ‘The one is opposed then to the many in numbers as measure to things measureable; and these are opposed as relatives which are not from their very nature relatives.’ (Met., I, 1056b32-34) 4) Definition of relative Aristotle’s first definition of the category of relative (πρός τι) is as such: ‘We call relative all such things as are said to be just what they are, of or than other things, or in some other way in relation to something else (Πρός τι δὲ τὰ τοιαῦτα λέγεται, ὃσα αὐτὰ ἃπερ ἐστὶν ἓτερων εἶναι λέγεται, ἢ ὁπωσοῦν ἄλλως πρὸς ἓτερον). (Cat., 7, 6a36-37; repeated almost without any change in: Cat., 7, 6b6-8) Aristotle’s examples are larger (because it is what it is than something else (τοῦθ᾿ ὃπερ ἐστὶν ἑτέρου λέγεται) that means it is called larger than something) and double. (Cat., 7, 6a37-b1) Aristotle’s aporia regarding relative is about their relation with substances: whether no substance is spoken of as a relative, or whether this is possible with regard to some secondary substances. (Cat., 7, 8a13-15) In the case of primary substances, it seems that he is confident, at least at first, that neither themselves nor their parts are spoken of in relation to anything: neither an individual man is called someone’s individual man nor an individual hand is called someone’s individual hand (but someone’s hand). (Cat., 7, 8a15-21) Although it is obvious that most of secondary substances are not spoken of as relatives (a man is not called someone’s man) (Cat., 7, 8a21-25), there are some with them there is room for dispute: a head is someone’s head and a hand is called someone’s hand, which seem to be relatives. (Cat., 7, 8a25-28) Aristotle thinks this must be due to the previous definition’s being problematic: with that definition ‘it is either exceedingly difficult or impossible to reach the solution that no substance is spoken of as a relative.’ (Cat., 7, 8a28-32) Thus, Aristotle changes his previous definition to a new one: ‘Those things are relatives for which being is the same as being somehow related to something’ (ἔστι τὰ πρός τι οἷς τὸ εἶναι ταὐτόν ἐστι τῷ πρός τί). (Cat., 7, 8a32-34) Although the first definition does indeed apply to all relations, its problem is that it does not take ‘their own being relative’ (τῷ πρός τι αὐτοῖς εἶναι) the same as ‘their being what they are of other things’ (ἃπερ ἐστὶν ἑτέρων λέγεσθαι). (Cat., 7, 8a34-37) Although this change of definition is to exclude all substances from being relative, what Aristotle says in Topics (To., Z, 8, 146a39- ), seems to ignore this: ‘For of everything relative the substance is relative to something else, seeing that the being of every relative term is identical with being in a certain relation to something.’ 5) Necessary knowledge of the related Knowledge of that in relation to which a relative is spoken of is necessary when one knows the relative: it is impossible to know a relative and at the same time not to know that in relation to which it is spoken of. (Cat., 7, 8a37-b3) To prove this, Aristotle adheres to the definition of relatives: ‘If someone knows of a certain ‘this’ that it is a relative, and being for relatives is the same as being somehow related to something, he knows that also to which this is somehow related.’ (Cat., 7, 8a37-b3; cf. 7, 8b3-15 for Aristotle’s examples) This necessary knowledge of the related, if we call it so, dedicates Aristotle an epistemological reason, besides the ontological one mentioned in his definition, for the exclusion of substances. As we noted in our discussion of Aristotle’s definition of relatives, he changed his first definition to exclude all substances from being relatives. Therefore, it is evident that for him relatives must not include substances, either primary or secondary. Aristotle does have no problem with primary substances simply because it is evident for him that they cannot be relatives. The same can be said about most of the secondary substances as well. The problem for which he changed the definition of substances was about some secondary substances like ‘head’ or ‘hand’: the fact that it is possible to know a hand or head without necessarily knowing definitely that in relation to which it is spoken of proves that they are not relatives. (Cat., 7, 8b15-21) 6) Reciprocation Aristotle regards reciprocation (ἀντιστρέφειν) necessary in all relations: ‘All relatives are spoken of in relation to correlatives that reciprocate.’ (Cat., 7, 6b28-29; cf. Cat., 10, 12b21-24) The sense of reciprocation is clear by his own examples: ‘The slave is called slave of a master and the master is called master of a slave; the double double of a half, and the half half of a double.’ (Cat., 7, 6b29-31) Reciprocation of relatives is so necessary that if there seems that we do not have reciprocation, it must necessarily be due to a mistake and that in relation to which something is spoken of must have not been given properly. (Cat., 7, 6b36-7a1) Aristotle’s example is this: If a wing is given as of a bird, ‘bird of a wing’ does not reciprocate because it has not been given properly: a wing is of a winged and not of a bird; a wing is wing of a winged and a winged is winged with a wing. (Cat., 7, 7a1-5) Even if we do not have a proper name to have a proper reciprocation, Aristotle points, we must invent names. (Cat., 7, 7a5-15 and 7b10-14) Thus, having proper names is the condition of necessary reciprocation: ‘All relatives are spoken of in relation to correlatives that reciprocate, provided they are properly given.’ (Cat., 7, 7a22-23) This condition is also said in another way: there is no reciprocation if a relation is given as related to some chance thing or to something that is accidentally the related thing like when, for example, a slave is given as of a man or a biped instead of being given as of a master. (Cat., 7, 7a25-31) 7) Simultaneity of relatives Aristotle believes that in most cases relatives are simultaneous: double and half or master and slave must exist at the same time: when there is a half, there is a double and when there is a slave, there is a master. (Cat., 7, 7b10-14) However, this receives some exceptions like knowable, which is prior and can, thus, exist before and without knowledge. (Cat., 7, 7b22-27) What approves this non-simultaneousness for Aristotle is that the destruction of knowledge does not carry the knowable to destruction. (Cat., 7, 7b27-31) The same is said about perception and perceptible. (Cat., 7, 7b35-8a9) Aristotle attaches simultaneity to reciprocation. This reciprocation, however, is not a simple reciprocation but ‘reciprocation as to implication of existence’ (ἀντιστρέφει μὲν κατὰ τὴν τοῦ εἶναι) with the condition that neither be in any way the cause of the other’s existence. (Cat., 13, 14b27-29; the same is said also at: Cat., 13, 15a4-11) Aristotle’s examples are the double and the half because when there is a double there is a half and when there is a half there is a double but neither is the cause of the other’s existence. (Cat., 13, 14b29-32) (We have ‘reciprocation as to implication of existence’ also in relation between genus and species but it seems that this has a totally different sense there. 8) Having no independent reality That a relative cannot be a substance, either a primary or a secondary substance, is discussed in our review of both the definition of relatives and their reciprocation. The differentiation of relatives and substances are so deep for Aristotle that after questioning the possibility of any common element or principle for substances and relatives (Met., Λ, 1070a33-36), he asserts that no substance, on the one hand, is the element of relatives and none of the relatives, on the other hand, is the element of substances. (Met., Λ, 1070b3-4) Aristotle does not, however, suffice to this. For him, relatives have the least substantiality, which is, for him, almost the same as reality: ‘The relative is least of all categories a real thing (φύσις τις) or substance, and less than quality and quantity; and the relative is an affection of quantity.’ (Met., M, 1088a22-25) Aristotle believes that an evidence of this least reality (ὄν) and substantiality is that relatives have no proper generation, destruction or movement while each of substance, quality and quantity have them. (Met., M, 1088a29-35) Moreover, neither motion (Phy., E, 1) nor any kind of change is applicable to relatives so that relatives are neither themselves alterations nor the subject of alterations (Phy., Z, 3) and the process of losing and acquiring states cannot be considered as alterations because these are the result of the alterations of non-relative things of which they are states. (Phy., Z, 3) Relative is not even matter but is something different. (Met., M, 1088a24-25) The reason is that the matter is potentially of a nature but relative is neither potentially nor actually of a nature. (Met., M, 1088b1-2) To understand the status of relatives in Aristotle’s world, we have to make a tripartite classification; a classification that though Aristotle himself did not make, his assertions approve it. Based on this division, there are three kinds of being in the world: i) Independent beings: This class includes only substances. ii) Dependent beings: This class includes qualities and quantities. Although they are real, they are ‘in’ substances and cannot exist without them. iii) Super dependent beings: This class includes at least relatives. The fact that relatives must be considered in a third class different from substances, on the one hand, and qualities and quantities, on the other hand, is obvious not only from the previously mentioned texts (Met., M, 1088a22-25, 29-35 and b1-2) in which relatives’ reality is considered less than all substances, qualities and quantities and different from matters but from this text: ‘For there is nothing either great or small, many or few, or, in general, relative which is not something (τι ὄν) different (ἓτερον) [that is also] many or few or great or small’. (Met, N, 1088a27-30) Therefore, super dependent beings are those beings that must necessarily be also something else, i.e. an independent or dependent being. Ackrill (1963, 99) points that some of the words used by Aristotle to exemplify relational entities, e.g. slave, are endowed with a complete sense and do not need to be supplemented by a correlate. (Thus, the linguist criterion of incompleteness would be deficient. Some other instances of relative entities like ‘state,’ ‘knowledge’ and perception are not necessarily followed by the genitive case. 9) Extent of relatives What is the extent of relatives? What are or are not included in relatives either among categories or among other concepts? Which concepts or things Aristotle regard as relative? i) Aristotle includes state (ἓξις) and position (θέσις) among relatives. (Cat., 7, 6b2-6; Cat., 7, 6b11-14; Cat., 8, 11a20-24) ii) Although relative is not matter but is something different (Met., M, 1088a24-25), matter is ‘non-being’ only in virtue of an attribute (Phy., A, 9) and is, thus, a relative term. (Phy., B, 2, 194b9) 10) Property and relativity Aristotle draws a contrast between two types of giving a property, absolute and relative: ‘A property is given either in its own right and for always or relative to something else and for a time.’ (To., E, 1, ^128b15-18) Being a civilized man, for example, is an absolute property for man while to command is a relative property for the soul. The absolute property, however, is considered not only potential to be discussed or observed in relation to many things or periods of time, it in fact ‘belongs to its subject relatively to every single thing that there is, so that if the subject is not distinguished relatively to everything else, the property will not have been given correctly.’ (To., E, 1, 129a18-20) Therefore, an absolute property is a property that ‘is ascribed to a thing in comparison with everything else and distinguishes it from everything else.’ (To., E, 1, 128b33- ) An absolute property is, then, absolutely relative and not conditionally relative, i.e. relative to a specific thing. This is what differentiates it from a relative property, which is relative to a certain thing: ‘A property relative to something else is one which separates its subject off not from everything else but from a particular definite thing.’ (To., E, 1, 128b33- ) One important difference between absolute and relative properties is that while an accident can be a relative property, it can never be an absolute property. (To., I, 5, ^102b20-36) For example, sitting, which is an accident, is also a property relatively to those who are not sitting. (To., I, 5, ^102b20-36) 11) Platonic theories as relatives At least three of Platonic theories Aristotle attaches to relatives: i) Forms ‘It seems that a Form is always spoken of in relation to a Form-this desire itself is for the pleasure itself, and wishing itself is for the good itself.’ (To., Z, 8, 147a^10) Moreover, the theory of Forms takes the relative prior to the absolute as, for example, it takes not the dyad but the number as first. (Met., A, 990b15-17) Aristotle believes that this is against not only the necessities of the case but only the Platonists’ opinion because Forms must be substances only, if they can be shared. (Met., A, 990b27-29) There are, however, things like ‘equal’ which are only relative: they are only in relation to something else. Now the theory that ideas are supposed to be substances only should entail the substantiality of merely relatives. The reason being that Forms are not shared incidentally but each thing shares in that which is not predicated of a subject. (Met., A, 990b29-31) ii) Unequal The Platonic theory of great and small or unequal, which we know more from Aristotle and has, in Platonic philosophy, a role like that of matter in Aristotelian philosophy, is also called relative by Aristole. (Met., M, 1089b4-15) iii) Potentiality Aristotle says that Platonists take what potentially is a ‘this’ and a substance but not actually so a relative because it is ‘neither potentially the one or being, nor the contradictory of the one nor of being, but one among beings.’ (Met., N, 1089b15-20) 12) All things as relative Aristotle attaches the theory that ‘everything is true’ to relativity and thinks the consequence of believing in this theory is that everything is true: ‘He who says all things that appear are true, makes all things relative.’ (Met., Γ, 1011a17-20) 13) Genera and species of relatives There are some genera, Aristotle hints, that are relative but their species are not relative. In such cases, the genera are spoken of in relation to something, but none of the particular cases are so spoken. (Cat., 8, 11a20-36) Aristole’s examples are knowledge and grammar of which the former is a relative but the latter is a quality. The consequence of this is that there is nothing absurd for a thing to be in both genera of relative and quality. (Cat., 8, 11a37- ) However, when the species is a relative, the genera will be a relative too. (To., Δ, 4, 124b15- ) Moreover, Aristotle asserts that ‘the differentiae of relative terms are themselves relative.’ (To., Z, 6, 145a14-16) Things that are called relative are called so, Aristotle says, ‘because the classes that include them are of this sort, e.g. medicine is thought to be relative bcs its genus, knowledge, is thought to be relative,’ (Met., Δ, 1021b4-6) 14) Relatives as indefinite? Fabio Morales takes 1088a29-b1 as a textual evidence supporting the assumption that Aristotle regarded relational terms as indefinite. (shrink)

Research in pharmacogenomics and precision medicine has recently introduced the concept of Polygenic Scores (PGSs), namely, indexes that aggregate the effects that many genetic variants are predicted to have on individual disease risk. The popularity of PGSs is increasing rapidly, but surprisingly little attention has been paid to the idealisations they make about phenotypic development. Indeed, PGSs rely on quantitative genetics models and methods, which involve considerable theoretical assumptions that have been questioned on various grounds. This comes with epistemological (...) and ethical concerns about the use of PGSs in clinical decision-making. In this paper, I investigate to what extent idealisations in genetics models can impact the data gathering and clinical interpretation of genomics findings, particularly the calculation and predictive accuracy of PGSs. Although idealisations are considered ineliminable components of scientific models, they may be legitimate or not depending on the epistemic aims of a model. I thus analyse how various idealisations have been introduced in classical models and progressively readapted throughout the history of genetic theorising. Notably, this process involved important changes in the epistemic purpose of such idealisations, which raises the question of whether they are legitimate in the context of contemporary genomics. (shrink)

Each of us is a measure. The project of advocates of change in Plato’s Theaetetus as compared with sophistic thought -/- Summary -/- One of the most intriguing motives in Plato’s Theaetetus is its historical-based division of philosophy, which revolves around the concepts of rest (represented by Parmenides and his disciples) and change (represented by Protagoras, Homer, Empedocles, and Epicharmus). This unique approach gives an opportunity to reconstruct the views of marginalized trend of early Greek philosophy - so called „the (...) sophistic movement”. Paradoxically, previous research shows little interest in sophistic thought as a source of the standpoint of advocates of change („the secret doctrine”). The roots of „the secret doctrine” were investigated in the works of Heraclitus, Aristippus, and Antisthenes or those related to “neoheracliteanism”. However, researchers did not make any significant attempt to confront this concept with the contemporary research on the sophistic movement. The conviction that sophistry was primarily humanistically oriented was one of the main reasons why researches were opposed to the fact that „the secret doctrine” could represent a true expression of Protagoras’ views. This is why J. Burnet and F. M. Cornford in their seminal works assumed that “the secret doctrine” should be attributed to Plato, who simply combined a series of loose statements into one single project. In this work, we argue that the thesis which questions the parallels between the sophists’ interests and the philosophers of nature requires a significant revision. There is ample evidence to suggest that the philosophy of nature was a part of sophists’ research. This is supported by two main arguments. First, the tutors of sophists were philosophers of nature. Second, there are numerous sources that explicitly show sophists’ interest in the physical issues. These sources include anecdotal evidence about the fact that sophists wrote works On nature. There is also information confirming that they deliberated on detailed physical issues. The analogies between the concepts attributed to the advocates of change and our knowledge about sophists from other sources is very wide and contains most elements, which are included in the project of “changeable reality” presented in Theaetetus. The deliberations on the mechanism of perception, which are close to those of flux theory of perception in Theaetetus, are present in the sources referring to Gorgias of Leontinoi, the famous sophist and rhetorician. Also, the second element of “the secret doctrine” that is the metaphysics of flux matches up with what we know about the sophists’ views from other sources. On this basis, one can deduce that – contrary to the tradition which marginalized the role of sophistic considerations on the issue of being and non-being – it was one of the major subjects of sophistic research. Its main point was the criticism of the Eleatic conception of a single and unchangeable being, which also plays a key role in the doctrine of flux in Theaetetus. The epistemological theses which are presented in Theaetetus are borne out in sophistic sources. They include the definition of knowledge as perception, the „Man-measure” formula and a number of principles, which result from these foundational theses. Sophists’ empirical preferences resonate with the theses of the advocates of change in Theaetetus. Special attention that is given to the issues of differences among people, and even to cognitive differences in one person depending on the changeable states to which a person is subject, goes well together with what we know about reciprocal influence between the sophistry and medicine. The consequences of the epistemological conception present in Theaetetus have their equivalents in sophists’ works and other testimonies. An example of these consequences may be the abolition of truth and falsehood or the abolition of contradiction, which finds its expression in the thesis ouk estin antilegein. The analogies also concern reflections on the language itself. The project of the “new language” uses categories, which were developed by sophists. These include the antithesis of nomos and physis. The general intentions of this project reflect Protagoras’ ideas, at least to the extent to which they are known from the sources reporting his thoughts on language. Plato’s Theaetetus can thus be considered a veritable treasury of sophistic motifs. Even though the problem remains unsolved and one is still not able to unambiguously decide about the author of “the secret doctrine”, one can come to a certain conclusion – even if Plato synthesized various doctrines, he must have relied in his project mostly on the elements that he borrowed from sophists. Moreover, the value of reconstructing the project of the advocates of change in Theaetetus does not consist of mere enumeration of sophistic motifs. The dialogue is key to understanding the sophistic movement, whose separate doctrines – for the lack of sources and as a result of centuries-old disregard – are usually treated as rhetorical formulae that are interpreted in many ways and have no philosophical foundations. If it is really the case that the theses attributed to Protagoras in Theaetetus were actually a part or a derivative of Protagoras’ thought, or – speaking more conservatively – if they constitute a synthesis of sophistic thought done by Plato, they could represent philosophical foundations for the most important sophistic theses: the “Man-measure” formula, the ouk estin antilegein principle, the concept of language as a tool, the idea of the relativity of good and the whole practical sphere of sophists’ activity. Contrary to the views of many researchers, we are certain that the representatives of the sophistic movement did not limit themselves only to the application of practical rules, which determined the extent of their educational or rhetorical-political activity. They were capable of creating – indeed, they did create comprehensive projects that embraced the whole thematic scope subject to philosophical reflection. (shrink)

Motivated by a recent trend that advocates a reassessment of the aim of medical science and clinical practice, this paper investigates the epistemic aims of biomedical research. Drawing on contemporary discussions in epistemology and the philosophy of science, along with a recent study on scurvy, this paper (1) explores the concept of understanding as the aim of scientific inquiry and (2) establishes a framework that will guide the examination of its forms in biomedical research. Using the case of Tuberculosis (...) (TB), (3) it is argued that grasping a mechanistic explanation is crucial for reaching a threshold of understanding at which we may speak of an objectual, biomedical understanding of TB. (shrink)

We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either (...) be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon. (shrink)

Recent advancements in artificial intelligence have fueled widespread academic discourse on the ethics of AI within and across a diverse set of disciplines. One notable subfield of AI ethics is machine ethics, which seeks to implement ethical considerations into AI systems. However, since different research efforts within machine ethics have discipline-specific concepts, practices, and goals, the resulting body of work is pestered with conflict and confusion as opposed to fruitful synergies. The aim of this paper is to explore ways to (...) alleviate these issues, both on a practical and theoretical level of analysis. First, we describe two approaches to machine ethics: the philosophical approach and the engineering approach and show how tensions between the two arise due to discipline specific practices and aims. Using the concept of disciplinary capture, we then discuss potential promises and pitfalls to cross-disciplinary collaboration. Drawing on recent work in philosophy of science, we finally describe how metacognitive scaffolds can be used to avoid epistemological obstacles and foster innovative collaboration in AI ethics in general and machine ethics in particular. (shrink)

Karl Philipp Moritz edited Gnothi Sauton, the Journal of Empirical Psychology (1783-1793), which stands as the first of numerous psychological and psychiatric periodicals. We evaluated 124 psychiatric or neurological case reports from the journal according to modern diagnostic criteria and present a brief outline of the contributors' and patients' sociodemographic characteristics, selected case reports and the surmised risk factors. A reliable diagnostic reassignment of the well-described cases was feasible; this may indicate that patients retain similar psychiatric disturbances over the centuries. (...) As in the popular literature of the period, examples of' sentimental students' and 'desperate soldiers' represented the most frequently discussed, prototypical high-risk personalities in the Journal, which marked the step from literature to empirical science. The influences of this case material upon contemporary psychiatric writing and thought are reviewed. (shrink)

Sometimes we learn through the use of imagination. The epistemology of imagination asks how this is possible. One barrier to progress on this question has been a lack of agreement on how to characterize imagination; for example, is imagination a mental state, ability, character trait, or cognitive process? This paper argues that we should characterize imagination as a cognitive ability, exercises of which are cognitive processes. Following dual process theories of cognition developed in cognitive science, the set of imaginative (...) processes is then divided into two kinds: one that is unconscious, uncontrolled, and effortless, and another that is conscious, controlled, and effortful. This paper outlines the different epistemological strengths and weaknesses of the two kinds of imaginative process, and argues that a dual process model of imagination helpfully resolves or clarifies issues in the epistemology of imagination and the closely related epistemology of thought experiments. (shrink)

Cancer research is experiencing ‘paradigm instability’, since there are two rival theories of carcinogenesis which confront themselves, namely the somatic mutation theory and the tissue organization field theory. Despite this theoretical uncertainty, a huge quantity of data is available thanks to the improvement of genome sequencing techniques. Some authors think that the development of new statistical tools will be able to overcome the lack of a shared theoretical perspective on cancer by amalgamating as many data as possible. We think instead (...) that a deeper understanding of cancer can be achieved by means of more theoretical work, rather than by merely accumulating more data. To support our thesis, we introduce the analytic view of theory development, which rests on the concept of plausibility, and make clear in what sense plausibility and probability are distinct concepts. Then, the concept of plausibility is used to point out the ineliminable role played by the epistemic subject in the development of statistical tools and in the process of theory assessment. We then move to address a central issue in cancer research, namely the relevance of computational tools developed by bioinformaticists to detect driver mutations in the debate between the two main rival theories of carcinogenesis. Finally, we briefly extend our considerations on the role that plausibility plays in evidence amalgamation from cancer research to the more general issue of the divergences between frequentists and Bayesians in the philosophy of medicine and statistics. We argue that taking into account plausibility-based considerations can lead to clarify some epistemological shortcomings that afflict both these perspectives. (shrink)

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the (...) objection that the Autonomy Thesis is overly permissive and allows many highly controversial procedures as legitimate parts of medicine. (shrink)

Root, branch, and blossom, attention is intertwined with epistemology. It is essential to our capacity to learn and decisive of the evidence we obtain, it influences the intellectual connections we forge and those we remember, and it is the cognitive tool whereby we enact decisions about inquiry. Moreover, because it is both an epistemic practice and a site of agency, attention is a natural locus for questions about epistemic morality. This article surveys the emerging epistemology of attention, reviewing (...) the existing literature and sketching avenues for future investigation. It also argues for a reorientation of epistemology itself. This argument is the focus of Section 1. Section 2 briefly reviews philosophical accounts of attention, Section 3 focuses on issues in traditional, individualistic epistemology, and Section 4 turns to social epistemology. (shrink)

This article surveys recent developments in the epistemology of modality.

Article Summary. The epistemology of disagreement studies the epistemically relevant aspects of the interaction between parties who hold diverging opinions about a given subject matter. The central question that the epistemology of disagreement purports to answer is how the involved parties should resolve an instance of disagreement. Answers to this central question largely depend on the epistemic position of each party before disagreement occurs. Two parties are equally positioned from an epistemic standpoint—namely, they are epistemic peers—to the extent (...) that they have roughly equal access to the evidence and comparable intellectual resources. When one party is epistemically better positioned than the other—that is, when one is an epistemic superior—it is widely agreed that this party should retain their belief while the other party—the epistemic inferior—should revise their opinion in the direction of what the epistemic superior believes. Addressing the central question is a complex task when the disagreeing parties are epistemic peers. Three main answers can be distinguished. Conciliatory answers mandate that both parties revise—i.e. lower their confidence in—their beliefs upon the occurrence of peer disagreement. Steadfast answers allow both parties to retain their respective beliefs, thereby committing them to demote the epistemic position of the interlocutor. The third group of answers suggests that the solution to peer disagreement depends on whether either party is highly justified in holding their belief. If either party is highly justified, then it is rational that this party retains its view. If neither party is highly justified, both should revise. The epistemology of disagreement addresses further important questions such as: whether the occurrence of disagreement opens the doors to skepticism and/or relativism; what the consequences of epistemic disagreement on intellectual character are; what laypeople should do when experts disagree with each other; and whether disagreement among groups can be treated in the same way as disagreement among individuals. (shrink)