Disease, Misc

‘Disease interception’ describes the treatment of a disease in its clinically inapparent phase and is increasingly used in medical literature. However, no precise definition, much less an ethical evaluation, has been developed yet. This article starts with a definition of ‘disease interception’ by distinguishing it from other preventions. It then analyses the ethical and social implications of the concept in light of the four principles of medical ethics by Beauchamp and Childress. The term ‘disease interception’ refers to a form of (...) secondary prevention applied in a short interception window intended to prevent a preclinical disease from developing further. We propose the definition ‘early and targeted secondary prevention by treatment’. The ethical evaluation of the concept shows that while it promises to be beneficial, it raises a number of ethical and social challenges regarding patient autonomy and justice. In order to ensure decision-making that respects patient autonomy, commercially motivated metaphors such as ‘disease interception’ should make way for precise definitions. Future research should not only focus on how to detect clinically inapparent diseases but also on the ethical question, when this is justifiable and what consequences it has for the individual and society as a whole. (shrink)

A large part of contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of healthcare. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we – as embodied beings – engage with health-promoting behaviours. It specifically considers how we (...) engage with oral hygiene regimes to prevent periodontitis and why we are not good at it. The article suggests that poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, as prevention of disease is generally concerned with pre-symptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint. (shrink)

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

In the ongoing pandemic, death statistics influence people’s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization’s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts and values.

In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/chronic fatigue syndrome as an ‘illness without disease’, citing the absence of identified diagnostic markers. They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy and graded exercise therapy, to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’. In response, we explain that understandings about the causes of and treatments for medical complaints have shifted (...) across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes. We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach. In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’. (shrink)

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that these claims are (...) unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model. (shrink)

According to the medical world, hysteria is a thing of the past, an outdated diagnosis that has disappeared for good. This book argues that hysteria is in fact alive and well. Hyperventilating, we rush from one incident into the next - there is hardly time for a breather. From the worldwide run on toilet paper to cope with coronavirus fears to the overheated discussions about immigration and overwrought reactions to the levels of crime and disorder around us, we live in (...) a culture of hysteria. While hysteria is typically discussed in emotional terms - as an obstacle to be overcome - it nevertheless has very real consequences in everyday life. Irritating though this may be, hysteria needs to be taken seriously, for what it tells us about our society and way of life. That is why Marc Schuilenburg examines what hysteria is and why it is fuelled by a culture that not only abuses, but also encourages and rewards it. Written in a clear and direct style, this book will appeal to students and scholars of sociology, criminology, philosophy and all those interested in hysteria and how it permeates late modern society. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

In 1937, John Dewey delivered a lecture to the College of Physicians in Saint Louis. His clear message was that in the practice of medicine it does not suffice for physicians to treat just the body, or to look to just the body for the mechanism of disease. Emphasizing the relational nature of organism-environment, he argued that the physician must treat the whole patient and must therefore consider the environment of the patient. It makes no sense, he suggested, to provide (...) medicine to address a problem with the patient's lungs and then to send him back into the coal mine. As he put it: "We must observe and understand internal processes and their interactions from the standpoint of their interactions with what is... (shrink)

In this paper, we examine how polycystic ovary syndrome is racialized in biomedical research. Drawing from Star’s seminal concept of triangulation, we analyze how the diagnostic criteria for PCOS combine two different biomarkers: body hair and testosterone. Hair and hormones are both haunted by their use in eugenic research, and as clinical measures, they can carry forward powerful narratives of biological difference. PCOS researchers circulate strong claims about racial difference in hirsutism as if they were established knowledge, sometimes calling for (...) race-specific diagnostic thresholds. Tracing the links between race and hirsutism, hirsutism and testosterone, and testosterone and race, we find that these connections are all conceptualized in ambiguous and inconsistent ways. Through triangulation, the uncertainty clouding each link is mitigated by the apparent strength of the chain as a whole. The logic linking race to disease is attenuated, allowing race to persist as a ghost variable. As PCOS is increasingly reframed as a risk factor for other conditions, racial stratification is submerged, implicit but actionable, at every stage of the life course cascade of risk. (shrink)

Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and (...) often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention—but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality. (shrink)

In ‘Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox’, authors Michael Sharpe and Monica Greco begin by characterising myalgic encephalomyelitis/chronic fatigue syndrome as illness-without-disease. On that basis they ask why patients reject treatments for illness-without-disease, and they answer with a philosophical idea. Whitehead’s ‘bifurcation of nature’, they suggest, still dominates public and professional thinking, and that conceptual confusion leads patients to reject the treatment they need. A great deal has occurred, however, since Whitehead characterised his (...) culture’s confusions 100 years ago. In our time, I suggest, experience is no longer construed as an invalid second cousin of bodily states in philosophy, in medicine or in the culture at large. More importantly, we must evaluate medical explanations before we reach for philosophical alternatives. The National Institutes of Health and the Institute of Medicine have concluded that ME/CFS is, in fact, a biomedical disease, and all US governmental health organisations now agree. Although it would be productive for Sharpe and Greco to state and support their disagreement with the other side of the disease debate, it is no longer tenable, or safe, to ignore the possibility of disease in patients with ME/CFS, or to recommend that clinicians should do so. When we find ourselves in a framework that suggests the possibility of medical need is somehow beside the point for medical providers, it is time to reconsider our conceptual foundations. (shrink)

In the pursuit to offer validity and lineage to the modern diagnosis of post-traumatic stress disorder, non-historical scholars often remove ancient episodes from their social context and retrospectively diagnose them based on our modern diagnostic criteria. This approach reinforces our pre-existing ideas, and form a confirmation bias that does not help to grow our understanding of these injuries. As this article argues, the use of ancient precedents would offer greater benefit to the psychological and medical profession when used to ask (...) new questions rather than reiterate old answers. This article addresses the use of ancient history in the psychological disciplines, especially concerning the topic of post-traumatic stress, and its earlier categorisation as shell shock. Before assessing the non-historical scholarship for the use of ancient precedents, this article sets out the historical debate around the topic and the methodological issues involved in using PTSD as a model with which to examine the ancient world. After which, the use of ancient history by psychological and medical researchers examining PTSD will be assessed. In turn, it will be shown how the removal of historical context has allowed misunderstandings of the original texts and for historical errors to permeate. The story of Epizelus, a man who went blind in battle without incurring any injury, will be used as a case study to show how ancient history has been misused, and vital parts of his life story have been ignored because they do not fit the modern diagnostic model. In particular this article will show how ancient episodes have been used to justify modern ideas and modern understanding, and propose new therapies, without the necessary historical due diligence. (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)

All living organisms are under stress imposed by their surrounding environments. They must adapt to their stressors to live and survive. At the forefront of this adaptation is a defense system called immunity. Immunity, as the most ancient cognitive apparatus with memory function, is present in all living organisms. In previous reports, minimal cognitive function was defined as a “biologized” concept—namely, perception of elements in a milieu, integration of perceived information, reaction according to integrated information, and memory of that experience. (...) In this study, I aim to explore the essential feature of immunity by synthesizing scientific facts and “metaphysicalizing” them with logical reasoning. As a result of my analysis, I have realized the essential element in immunity: the capacity to preserve the existence of organisms by regulating their physiology and pathology. Having further analyzed immunity with special reference to the philosophy of Baruch Spinoza and George Canguilhem, _conatus_ with normative activities is deeply embedded in immunity and may constitute its essential feature. Given that _conatus_ and normativity imply mental elements, including the judgment of good and bad or health and disease, it is possible to conclude that the essential function of immunity includes cognition with normative connotations. This inclusive view encourages us to rethink the fundamental nature and philosophical implications of immunity from the cognitive perspective. (shrink)

Frailty has recently become a diagnostic category for older adults in the United States. Although one may have spoken colloquially of an individual as frail in years past, it was not considered a medical condition with a specific and quantifiable definition. Currently, the generally cited medical definition of frailty is “a biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiologic systems, and causing vulnerability to adverse outcomes”. The core elements of frailty are: “weakness, (...) poor endurance, weight loss, low physical activity, and slow gait”, and these factors, along with... (shrink)

The Danish physician Thomas Bartholin, famous for his work as an anatomist, also nourished a career-long interest in accounts of medicine in the Bible that resulted in a series of books on the topic. His final such work, On Biblical Diseases attracted a wide readership and was regarded by contemporaries as a model of an early modern practice called medicina sacra, the analysis of biblical accounts of disease and healing. Taking Biblical Diseases as a focal point, I investigate methods and (...) goals of early modern study of medicine in the Bible. Setting out early influences that shaped Bartholin’s development, I demonstrate connections between his work and its precursors. Examining Biblical Diseases itself, I indicate how Bartholin deployed contemporary medical, philological, theological, and historical knowledge to scrutinize biblical accounts. A brief glance at the reception of Biblical Diseases reveals that theologians and physicians alike utilized Bartholin’s work and how it influenced subsequent studies of medicine in the Bible. (shrink)

Poison and Disease in Anglo-Saxon Medicine and Metaphor bridges a gap between scholarship on medieval medicine and literary analysis of Anglo-Saxon literature by examining the relationship between beliefs about disease causation in medical recipe-books and the use of extended metaphors of illness in Old English poetry and other non-medical works. Chapter 1 takes a novel approach to identifying beliefs about the causes of disease by analyzing preventive prescriptions in the Old English Herbarium and Medicina de Quadrupedibus, two recipe-books that have (...) traditionally been considered practical rather than theoretical in content. These texts point toward attor or “poison” as a key concept in disease causation. In the next two chapters, my project explores the role of attor and related terms in works of Anglo-Saxon literature that make heavy use of medical metaphor. Chapter 2 performs a detailed study of the Old English poem Guthlac B, examining Saint Guthlac’s physical and spiritual experience of disease and how it relates to the poem’s account of Eve offering Adam a deadly drink in Eden. Drawing on evidence from Chapter 1, I argue that the poem’s two primary representations of death, as a battle and as a poisonous drink, are united by the quality of bitterness. While this quality binds Guthlac’s individual illness to Eve’s cup of death, it also evokes Christ’s bitter drink on the cross. The poem uses these associations to emphasize that the bitterness of physical pain does not have to lead to spiritual embitterment and distance from God. The final chapter examines medical metaphors in the penitentials, using previous scholarship on affective meditation as an interpretive framework. I identify three main categories of medical metaphor in the introductions to penitential manuals and argue that these metaphors, including imagery of poisoning and purgation, provide scripts for the cultivation of emotions crucial in penance. The chapter concludes with an examination of Soul and Body I, an Old English poem involving penitential themes that uses imagery of the corrupted body to encourage a spiritually desirable emotional response. Overall, this project argues for the importance of considering concepts of disease in analysis of Anglo-Saxon literature. (shrink)

Resumen En el presente trabajo se investigan los alcances y las consecuencias que se desprenden de utilizar a Heidegger en el campo de la filosofía de la medicina. Con este fin, la investigación se divide en los siguientes puntos: 1) se explicitará en qué puede consistir una “antropologización” del pensamiento heideggeriano; 2) se ofrecerá una descripción general respecto de las teorías de la salud y enfermedad más significativas y actuales en el campo de la teoría de la medicina; 3) nos (...) detendremos en el análisis relacionado con el problema de la enfermedad desde una perspectiva heideggeriana, para finalmente, 4) ofrecer algunas reflexiones críticas en relación con el análisis ofrecido.In this contribution we investigate the scope and consequences that arise from applying Heidegger in the field of philosophy of medicine. For this purpose, the paper is divided in the following points: First, we will make explicit the meaning of an “anthropologization” of Heidegger's thought. Second, an overview of the most significant contemporary theories of health and disease in the field of theory of medicine will be offered. Third, we will interpret the meaning of disease from a Heideggerian perspective. Finally, 4) we will offer some critical reflections offered in relation to the analysis. (shrink)

'Cruel' simply ignores the supposed fact/value dichotomy and cheerfully allows itself to be used sometimes for a normative purpose and sometimes as a descriptive term.Personality disorders have always attracted considerable attention within the philosophy of psychiatry. It was not until two papers written by Louis Charland, however, that they simulated a wider and lively debate. The importance and, at least partly, the strength of Charland's analyses lie in the fact that they are relatively particular and focused in their...

The nature of the product to be discovered guides the reasoning to discover it. Biologists and medical researchers often search for mechanisms. The "new mechanistic philosophy of science" provides resources about the nature of biological mechanisms that aid the discovery of mechanisms. Here, we apply these resources to the discovery of mechanisms in medicine. A new diagrammatic representation of a disease mechanism chain indicates both what is known and, most significantly, what is not known at a given time, thereby guiding (...) the researcher and collaborators in discovery. Mechanisms of genetic diseases provide the examples. (shrink)

Psychiatry has a habit of ignoring its past, which is understandable but, in some instances, a mistake. It is my contention that some of the lacunae about mood disorder in today's psychiatric understanding and treatment may be illuminated by the medical lore captured in Burton's Anatomy of Melancholy (1621). The implications of the present analysis for network based accounts of depression seem to encourage a reconsideration of therapeutic and remedial principles based on those found in Burton's work.

‘Dancing mania’ has often been understood as an expression of purportedly ‘typical medieval’ mass hysteria. Yet evidence suggests that a better interpretation would be to see it as a disease, the idea of which was shaped by patterns tracing back to antique cosmology. During the later Middle Ages, this concept became reality as a form of suffering primarily determined by spiritual forces which typically struck only individuals or small groups in narrowly defined regions. This article closely examines a key shift (...) in the semiotic setting of how this disease was interpreted: During the 15th and early 16th centuries, it became medicalised and desacralized. Evidence of this development can be found in isolated instances of ‘dancing mania’ in towns of the Rhine and Moselle area which at first glance would appear to be of little significance. As a medical concept, ‘dancing mania’ would survive the Reformation, and as a concept of primarily medical understanding it would later be re-integrated into the renewed Catholic culture of the late 16th and 17th centuries. (shrink)

The definition of metabolic syndrome has been, and still is, extremely controversial. My purpose is not to give a solution to the associated debate but to argue that the controversy is at least partially due to the different ‘causal content’ of the various definitions: their theoretical validity and practical utility can be evaluated by reconstructing or making explicit the underlying causal structure. I will therefore propose to distinguish the alternative definitions according to the kinds of causal content they carry: definitions (...) grounded on associations, definitions presupposing a causal model built upon statistical associations, and definitions grounded on underlying mechanisms. I suggest that analysing definitions according to their causal content can be helpful in evaluating alternative definitions of some diseases. I want to show how the controversy over MetS suggests a distinction among three kinds of definitions based on how explicitly they characterise the syndrome in causal terms, and on the type of causality involved. I will call ‘type 1 definitions’ those definitions that are purely associative; ‘type 2 definitions’ the definitions based on statistical associations, plus generic medical and causal knowledge; and ‘type 3 definitions’ the definitions based on mechanisms. These kinds of definitions, although different, can be related to each other. A definition with more specific causal content may be useful in the evaluation of definitions characterised by a lower degree of causal specificity. Moreover, the identification of the type of causality involved is of help to constitute a good criterion for choosing among different definitions of a pathological entity. In section I introduce the controversy about MetS, in section I propose some remarks about medical definitions and their ‘causal import’, and in section I suggest that the different attitudes towards the definition of MetS are relevant to evaluate their explicative power. (shrink)

Histories of dynamic psychotherapy in the late 19th century have focused on practitioners in continental Europe, and interest in psychological therapies within British asylum psychiatry has been largely overlooked. Yet Daniel Hack Tuke is acknowledged as one of the earliest authors to use the term ‘psycho-therapeutics’, including a chapter on the topic in his 1872 volume, Illustrations of the Influence of the Mind upon the Body in Health and Disease. But what did Tuke mean by this concept, and what impact (...) did his ideas have on the practice of asylum psychiatry? At present, there is little consensus on this topic. Through in-depth examination of what psycho-therapeutics meant to Tuke, this article argues that late-19th-century asylum psychiatry cannot be easily separated into somatic and psychological strands. Tuke’s understanding of psycho-therapeutics was extremely broad, encompassing the entire field of medical practice. The universal force that he adopted to explain psychological therapies, ‘the Imagination’, was purported to show the power of the mind over the body, implying that techniques like hypnotism and suggestion might have an effect on any kind of symptom or illness. Acknowledging this aspect of Tuke’s work, I conclude, can help us better understand late-19th-century psychiatry – and medicine more generally – by acknowledging the lack of distinction between psychological and somatic in ‘psychological’ therapies. (shrink)

Causation is important when considering how an organism maintains health, why disease arises in a healthy person, and how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

In this paper, I examine the transition from zymotic views of disease to germ views in Britain in the mid-1800s. I argue that neither realist nor anti-realist accounts of theory-change can account for this case, because both rely on a well-defined notion of theory, which, as the paper will show, is inapplicable in this instance. After outlining the zymotic theory of disease, I show that, even though it hardly had anything in common with the germ theory, it was highly successful. (...) However, despite this success, it is not possible to identify stable elements that were carried over to the germ theory; thus, realists cannot account for the shift from one to the other. Anti-realists, however, don’t do much better: their focus tends to be on (radical) discontinuities across theories, yet the zymotic case does not exemplify this, either. Instead, there is a slow and complex evolution from zymotic to germ views, during which various zymotic elements are assimilated into the germ theory, until, eventually, none of the zymotic theory’s original elements are left. (shrink)

La relación de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y anatomopatológico constituye de forma indirecta un indicador de calidad de la atención médica. Son múltiples los ejemplos de enfermedades descubiertas o esclarecidas gracias a la autopsia, que tiene en la correlación clinicopatológica un basamento fundamental. Se estableció como objetivo de investigación describir los principales vínculos históricos entre las especialidades de medicina interna y anatomía patológica, que tienen como enlace esencial la correlación clínico patológica, atendiendo (...) a que no puede existir contradicción antagónica entre enfermo y enfermedad; la medicina interna y la anatomía patológica no pueden verse aisladas ni separadas. The difference and similarity relationship of death causes between the clinical and anatomy-pathological diagnosis is, indirectly, a medical care quality indicator. Thanks to autopsy, which has the clinical-pathological correlation as a main basis, numerous diseases have been discovered or clarified. Discovering the main historical relations between Internal Medicine and Pathological Anatomy specialties was established as the objective of the research. These specialties have the clinical-pathological correlation as a main link, taking into account that there cannot be a conflicting contradiction between the sick and the disease; Internal Medicine and Pathological Anatomy cannot be seen in an isolated or separate way. (shrink)

Introduction -- Introducing the concept of diagnostic cultures -- Psychiatric diagnoses as epistemic objects -- Languages of suffering -- Psychiatric diagnoses as semiotic mediators -- "Do more, feel better, live longer": being a psychiatric subject -- Interpreting the epidemics -- Towards a comprehensive understanding of mental disorder -- General conclusions.

What is the origin of individual differences in ideology and personality? According to the parasite stress hypothesis, the structure of a society and the values of individuals within it are both influenced by the prevalence of infectious disease within the society's geographical region. High levels of infection threat are associated with more ethnocentric and collectivist social structures and greater adherence to social norms, as well as with socially conservative political ideology and less open but more conscientious personalities. Here we use (...) an agent-based model to explore a specific opportunities-parasites trade-off hypothesis, according to which utility-maximizing agents place themselves at an optimal point on a trade-off between the gains that may be achieved through accessing the resources of geographically or socially distant out-group members through openness to out-group interaction, and the losses arising due to consequently increased risks of exotic infection to which immunity has not been developed. We examine the evolution of cooperation and the formation of social groups within social networks, and we show that the groups that spontaneously form exhibit greater local rather than global cooperative networks when levels of infection are high. It is suggested that the OPTO model offers a first step toward understanding the specific mechanisms through which environmental conditions may influence cognition, ideology, personality, and social organization. (shrink)

Despite the upsurge of research on disgust, the implications of this research for the investigation of cultural pollution beliefs has yet to be adequately explored. In particular, the sensitivity of both disgust and pollution to a common set of elicitors suggests a common psychological basis, though several obstacles have prevented an integrative account, including methodological differences between the relevant disciplines. Employing a conciliatory framework that embraces both naturalistic and humanistic levels of explanation, this article examines the dynamic reciprocal process by (...) which contamination/contagion appraisals in individuals serve to shape—and are in turn shaped by—culture-specific pollution beliefs. This complex interrelationship is illustrated by examining ancient Near Eastern and modern ethnographic documentation of pollution beliefs, highlighting the underappreciated function of these pollution beliefs as folk theories for the spread of infectious disease. By evaluating how pollution beliefs shape contamination appraisals in individuals, it will be argued that cultural inheritance has played a much larger role in guiding disease avoidance behavior than has been previously recognized. (shrink)

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

The practice of the Western medicine often identifies the symptom with the disease itself, but a current of thought and medical practice considers it as the important message of an organic imbalance. In fact, in standard therapies symptoms are usually suppressed, thus interrupting a normal physiological process and risking severe reactions due to the organic imbalance. Dr. Hahnemann, the father of homeopathy, founded his diagnostic and therapeutic model on the interpretation of the symptoms and maintained that symptoms are an expression (...) of altered physiology. The same concept is to be found in Dr. Reckeweg's “reactivity” and homotoxicology; he believed that diseases are the expression of the struggle of the body against toxins. Reckeweg's contribution was particularly important in considering the inflammation process as a biologic process through which the body restores its health. Also PNEI proposes a model where the symptom is interpreted as information and as the res... (shrink)

The purpose is to identify common and distinctive features of concepts and methodology of the problem of subject within different discourses, implicitly or explicitly relevant to the definition of "clinical" mode of human existence. The research methodology combines techniques of discourse analysis and basic principles of historical and philosophical studies. Originality of the research lies in definition of the clinical philosophical discourse as a special communicative process, where utterances not only focus on disease syndromes, and reveal phenomenology of inner experience (...) of a pathological self, but also structure a certain type of sociality. Clinical discourse represents the space where the patient is treated not as a subject but as an object of disease. Ontology of clinical discourse prevails over ontology of disease, since its structures determine the notion of disease as such. Categorization of the disease, the idea of disease as a phenomenon subdued to professional authority leads to the idea of the need for patient’s isolation from the natural environment and removing him to special social institutions. The clinicist doctrines share the intention to reduce the patient’s self to its bodily dimension, while ignoring social determinants of psychological deviations. Conclusions of the study are summarized in the following positions: the current clinical discourse is based on the positivist-biological trend in humanitarian knowledge and it is the basis for the production and reproduction of medical and pharmaceutical repressive ideology; criticism of philosophical clinical discourse opens the possibility of overcoming the dominance of purely clinicist discourse; such a transformation is possible only after a paradigm shift in understanding the category of subject. (shrink)

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our knowledge of (...) this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are reallysubjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew (...) Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

The goal of this paper is two-fold: first, to emphasize causality in disease ontology and knowledge representation, presenting a general and cursory discussion of causality and causal chains; and second, to clarify and develop the River Flow Model of Diseases (RFM). The RFM is an ontological account of disease, representing the causal structure of pathology. It applies general knowledge of causality using the concept of causal chains. The river analogy of disease is explained, formal descriptions are offered, and the RFM (...) disease definition is refined by describing causal chains in terms of causal relations. The definition is updated to coincide with the actual RFM classes found in its upper-level ontology, YAMATO, which brings to light some challenges in developing both YAMATO and the RFM. The RFM is also discussed in relation to another ontological account of disease. Strategies are offered toward interoperability between these theories. (shrink)

Few topics in contemporary science hold the wide interest commanded by immunology, so this graceful and timely account of the development of this science is a welcomed addition to the literature. Succinct, well-written, and informed, Intolerant Bodies narrates the history of immunology through the lens of autoimmune disease. In what the authors call “a biography” , they have focused on four central illnesses: multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and type 1 diabetes mellitus. However, the story told here extends (...) far beyond the topic of “attack against self” to provide perhaps the best overview of immunity available for the general reader. The specialist will also appreciate the rich anecdotal material and benefit from the historical insights scattered throughout the text. So the book is, in fact, more than a history of autoimmunity and offers a compact history for those who need not consult more comprehensive accounts (e .. (shrink)

Almost every human disease has both a genetic and an environmental component. Even a classical inherited condition such as hemophilia can be influenced by external factors—in fact, most of the pathogenic effects of the mutation can be avoided by judicious injections of clotting factor, leading to a nearly normal life expectancy. For infectious diseases, often considered as essentially environmental, there are well-documented inherited differences in susceptibility, one of the most striking being the resistance to HIV infection of homozygous carriers of (...) the delta-32 mutation in the CCR5 gene (Dragic et al. 1996). Nevertheless, a number of conditions are “mostly genetic,” others “mostly environmental,” while many .. (shrink)

An invited editorial on the depiction of disease in art history which would then become the symbol of this redemptive philosophy.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we analyze (...) how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference. (shrink)

The term, idiopathic, emerged as a key concept in the classification of disease in the 18th century and has become ingrained in our terminology in defining diseases and their aetiologies throughout all fields of medicine. Despite, or perhaps because of this, little has been written about the meaning or meanings of the word itself. Although most medical professionals will be able to offer a definition of idiopathic, different definitions of the word are in use and are often confused or used (...) without an appreciation of the range of meanings. This article aims to clarify these different meanings with reference to historic and current uses. The change from the earlier nosological definition of ‘primary’ to the most widely accepted current definition, ‘of unknown cause’, occurred in the late 19th century, reflecting changing perspectives of disease causation. Far from being an innocent translation of ‘unknown’, idiopathic creates problems for future terminology and adds little to medical understanding. In masking the unknown, the term idiopathic maintains a paternalistic patient–practitioner relationship, and so should be avoided in modern medical terminology. (shrink)

Mitochondrial disease can be a devastating, degenerative illness, with limited treatment and no cure. Novel reproductive techniques involving mitochondria donation present an opportunity for women with mitochondrial disease to prevent the transmission of disease to her offspring. Current IVF techniques, such as pre-implantation genetic diagnosis, reduce but do not eliminate the risk for the child. However, knowledge of the contexts within which this disease is experienced and reproductive decisions are made is limited. This article draws on qualitative interviews with adult (...) patients to explore the practical realities of living with mitochondrial disease. Three key themes were identified; the personal and familial experiences of illness, age and generation as factors in shaping patient experience and the importance of experiential knowledge in making sense of reproductive choice. Overall, this article identifies potential barriers to patients accessing reproductive technologies highlighting how the complex nature and uncertain trajectory of mitochondrial disease poses considerable challenges for patients, practitioners and policy makers. (shrink)