This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates. The paper argues for two main claims of general interest in favour of these mandates. First, mask wearing mandates provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against mask wearing mandates may justify some (...) exemptions for specific categories of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against mask wearing mandates, governments should adopt such mandates. (shrink)
Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads to the very (...) uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny. (shrink)
The history of the research on peptic ulcer disease is characterized by a premature abandonment of the bacterial hypothesis, which subsequently had its comeback, leading to the discovery of Helicobacter pylori – the major cause of the disease. In this paper we examine the received view on this case, according to which the primary reason for the abandonment of the bacterial hypothesis in the mid-twentieth century was a large-scale study by a prominent gastroenterologist Palmer, which suggested no bacteria could be (...) found in the human stomach. To this end, we employ the methodof digital textual analysis and study the literature on the etiology of PUD published in the decade prior to Palmer’s article. Our findings suggest that the bacterial hypothesis had already been abandoned before the publication of Palmer’s paper, which challenges the widely held view that his study played a crucial role in the development of this episode. In view of this result, we argue that the PUD case does not illustrate harmful effects of a high degree of information flow, as it has frequently been claimed in the literature on network epistemology. Moreover, we argue that alternative examples of harmful effects of a high degree of information flow may be hard to find in the history of science. (shrink)
In this article, I present a philosophical account of medical treatment. In support of this account, I offer a suggestive account of medical conditions. The account of medical treatment uses three desiderata to demarcate treatment from non-treatment. Namely, a treatment should: (1) be describable by features that enable it to be standardized and characterized as a discrete intervention, (2) target a specific medical condition, and (3) have the possibility of being effective. The account of medical conditions underlies the second desideratum (...) and attempts to tie medical conditions closely to biological dysfunction, while also including some conditions for which biological dysfunction is absent or its presence uncertain. I offer a simple typology of treatments and show how the accounts are relevant to treatment effectiveness, disease, placebos, contested treatments, and treatment standardization. (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 this paper, I propose to bring forward the symptom of fatigue, and/ or exhaustion and burnout, brought up by the social-cultural speeds, rhythms, and acceleration, that manifests not only as quotidian tiredness and fatigue but also as what I will call an ontological burnout, that is, as an exhaustion of being as being. I will also refer to the concept of irritability and how I associate it with need, and to the concept of an-irritability (the absence of irritability) and (...) how I associate it with fatigue. In other words, how over-irritability or excessive irritability, mostly as encountered in humans, is a disorder of (bio)-rhythms, and how the constant, intensive satisfaction of need(s) leads to fatigue. (shrink)
An original study of late Enlightenment aesthetics, poetics, and environmental medicine as overlapping ways of comprehending the dislocations of historical existence lodged in the movements of bodies and minds This book studies later eighteenth-century medicine, aesthetics, and poetics as overlapping forms of knowledge increasingly concerned about the relationship between the geographical movements of persons displaced from home and the physiological or nervous "motions" within their bodies and minds. Looking beyond familiar narratives about medicine and art's shared therapeutic and harmonizing ideals, (...) this book explores Enlightenment and Romantic-era aesthetics and poetics in relation to a central but less well known area of eighteenth-century environmental medicine: pathology. No mere system of diagnosis or classification, philosophical pathology was an art of interpretation, offering sophisticated ways of reading the multiple conditions and causes of disease, however absent from perception, in their palpable, embodied effects. For medical, anthropological, environmental, and literary authors alike, it helped to locate the dislocations of modern mobility when a full view of their causes and conditions remained imperfectly understood or still unfolding. Goodman traces the surprising afterlife of the period's exemplary but unexplained pathology of motion, medical nostalgia, within aesthetic theory and poetics, arguing that nostalgia persisted there not as a named condition but as a set of formal principles and practices, perturbing claims about the harmony, freedom, and free play of the mind. (shrink)
Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease (...) can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)
By the end of the 1820s, an innovative product was introduced in the northern Italian editorial market: technical and popular periodicals offering “useful knowledge” to a larger audience composed of members of the provincial middle-class, clergymen, and modestly educated craftsmen. By examining their medical content, this paper shows that popularisation did not merely entail disseminating a set of stable, unanimous, and trustworthy medical doctrines; rather, it represented a crucial step in the making of science during a period in which medical (...) theories were still various and contradictory. Moreover, it demonstrates that the environmental and preventative approach to disease, which these medical contributors often employed, did reflect recent developments in chemical or physical knowledge and responded to pedagogical and informative goals; but it mostly served to affirm the social usefulness of medicine and the legitimacy of health professionals' participation in determining how to regulate more general epidemiologic, social, and political issues. (shrink)
We address ethical issues in the field of rare diseases (RDs) focusing on four aspects that are relevant for research and translation into clinical practice. First, the reuse of personal, health and genomic data, for research purposes, beyond the main purpose for which they were collected. Later, three aspects related to fundamental parts of clinical medicine such as diagnosis, treatment and prevention in relation to RDs. In this context, we address ethical aspects of research and its practical application that have (...) to do with the diagnostic effort in patients with undiagnosed diseases. A third topic is research programs in rare disease therapy and its translation into the treatment of patients. Finally, some points are discussed regarding the incorporation of genomic analysis in newborn screening, having the analysis of genetic variants as a complementary biomarker to biochemical tests that allows expanding the number of RDs in which to act preventively. (shrink)
A large part of the contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of health care. 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 regimens 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, because 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)
The overarching aim of this article is to scrutinize how severity can work as a qualifier for the moral impetus of malady. While there is agreement that malady is of negative value, there is disagreement about precisely how this is so. Nevertheless, alleviating disease, injury, and associated suffering is almost universally considered good. Furthermore, the strength of a diseased person’s moral claims for our attention and efforts will inevitably vary. This article starts by reflecting on what kind of moral impetus (...) malady incites. We then analyze how severity may qualify this impetus. We do so by discussing the relationship between severity and need, well-being and disvalue, death, urgency, rule of rescue, and distributive justice. We then summarize our thoughts about severity as a moral qualifier. We conclude that severity is, and should continue to be seen, as a morally significant concept that deserves continued attention in the future. (shrink)
The article dwells on the history of the formation of multiple stigmas of sick/poor people. The author describes medical and status characteristics that predetermine attitudes towards potential or real carriers of infectious diseases and poverty. Historical examples of the stigmatization of certain social groups in the era of the greatest epidemiological trouble until the middle of the 19th century are described.A content analysis of the discourse is carried out. It was based on the materials of a modern online publication and (...) included text-analyzes of the audience’ comments (n=133) to the news. The publication describes a conflict in a city cafe about the visitor who carries multiple stigmas. Statements that reflect the assessment of the identity of the stigmatized and the attitude of the audience towards him are given.Historical and cultural analysis made it possible to identify the continuity of discursive practices of stigmatization, the relevance for contemporaries of the historically established stereotypes of perception of a traditionally stigmatized category. (shrink)
Uchiyama et al. provide a theoretical framework to explain the gap between reported gene–environment interactions and real-life epidemiological statistics. Through cultural evolution, informed behavioral approaches mitigate the impact of environmental risk on disease onset. Similarly, here we propose that fostering certain behavioral traits, transmitted culturally or through access to scientific knowledge, could confer resilience to mental illnesses such as schizophrenia.
This article examines the discourses that are used by the British press to represent obesity in its coverage of coronavirus disease 2019 (COVID-19). Obesity is understood to be a risk factor for COVID-19, with people with obesity being more likely to die from the virus. This study adopts a corpus-based approach to Critical Discourse Studies and utilises a novel approach to keyword analysis, based on comparing analysis corpora against two reference corpora in order to yield keywords that are, in this (...) case, characteristic compared to general coverage of both COVID-19 and obesity. It is argued that the context of the pandemic has produced a range of discourses around obesity that are more stigmatising than usual in both the tabloids and the broadsheets, with people with obesity being construed, for example, in especially fatalistic terms and as being responsible for the problems facing the country’s healthcare system. At the same time, the pandemic context also seems to have given rise to some more positive changes to press coverage of obesity, with race-related health disparities receiving more focus than usual and the right-leaning press being more likely to critique the Conservative Government than it usually is, resulting in an arguably more balanced style of reporting. (shrink)
Desde mediados del siglo XX ha aumentado progresivamente la incidencia y prevalencia de la depresión y se ha llegado a considerar que existe una epidemia de depresión. Los autores que han analizado esta idea consideran que la evidencia no avala tales extremos, pero señalan diferentes factores explicativos propios del desarrollo histórico de la psiquiatría, de su situación interna y de su relación con la sociedad. Tales explicaciones guardan similitud con las características propias de un proceso de disease mongering que se (...) define por ampliar las fronteras de la enfermedad para expandir los mercados. Mostraré como una revisión del desarrollo histórico de la psiquiatría, en relación con estas posibles hipótesis explicativas, permite afirmar que ciertas actitudes o situaciones han podido fomentar un proceso de disease mongering asociado a intereses privados y valores de los agentes relevantes en el desarrollo de la psiquiatría en cuestiones como: creación de un método diagnóstico, innovación farmacológica y regulación de nuevos fármacos. Sin embargo, debido a limitaciones conceptuales o epistémicas, no se puede realizar una afirmación más fuerte. (shrink)
Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between the (...) different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (shrink)
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 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)
‘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)
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)
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 medical category with physical symptoms that define its diagnosis. This paper uses the resources of an ethics of care to analyze the relationship between frailty and fragility or vulnerability, the positives of frailty becoming a diagnostic category, and some problematic aspects of the same process.
Neglected diseases are severe conditions that mainly affect the world's poorest people. Those suffering from neglected diseases are mostly suffering from tropical infections that have failed to receive priority in pharmaceutical research and development programs, as well as in public health policies aimed at improving availability and access to preventive, diagnostic and curative medicine. The World Health Organization has issued a number of documents directing attention to the plight affecting one third of the world's population, assisted by active support from (...) private organizations, notably the Bill and Melissa Gates Foundation, but the overall situation remains dismal. In the wake of major socioeconomic processes including globalization, steadily growing economic disparity, healthcare inequality, the instability created by rogue states and terrorism, as well as massive migration, and epidemic outbreaks, the features of neglected diseases have been changing. Neglected populations affected by tropical diseases are suffering increasingly from non-infectious degenerative conditions and disabilities due to untreated chronic maladies. Pockets of poverty and neglect can also be detected in high-income countries, contributing to the emergence of new diseases and the reemergence of infections believed to be disappearing such as tuberculosis and the measles. Included in the issues of neglect are rare diseases, mostly of genetic origin, affecting a small number of patients that suffer from multiple life-shortening functional impairment and organ defects. Effective medicines are extremely expensive, allegedly because research and development of appropriate drugs is resources and time consuming, requiring exorbitant prices to recoup investment from a small number of consumers. Bioethics has been tardy in addressing the suffering and destitution of neglected and rare diseases. Convinced that permanently repeated denunciations blunt the sensitivity towards suffering, whereas statistics are bloodless and unable to elicit commitment, this book attempts to explore a different strategy. In an upstream approach, bioethics needs to engage in ethnographic fieldwork that confronts and shares the context in which people suffer, vividly presenting what epidemiological research has blunted into statistical data. Additionally, a downstream approach is suggested, requiring bioethics to vigorously and openly denounce unethical biomedical and pharmaceutical research, misdeeds in registration and marketing of drugs, and misalignment of policies with the unmet healthcare needs of the destitute. More than being critical observers, bioethicists ought to shed lurking conflicts of interests and seek active participation in planning research and public healthcare practices aimed at improving the lives of medically neglected populations. (shrink)
This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical concerns, and track its spread by the proliferation of disease language and diagnostic categories. Forensic psychiatry and disorders like psychopathy are often cited in these debates. I argue that focusing on discourse overlooks how medical language can justify or mask non-medical practices and outcomes, and lead researchers to identify medicalization where it has not occurred. Building on (...) other critiques of medicalization and recent studies of medical and legal expertise, I propose an alternative conception based on conditions for the performance of medical practice and other forms of expert labor. I distinguish the participation or intervention of medical practitioners from the medicalization of expert practice and identify several institutional factors that facilitate the latter. I illustrate this approach using a critical historical case: the first adult penal psychiatric clinic in the United States, founded by the eminent psychopathologist Bernard Glueck at New York’s Sing Sing Prison in 1916. Glueck’s extensive writings reveal little evidence of medicalization: psychopaths were largely defined and diagnosed according to penal rather than medical criteria, and they received additional punishment rather than treatment. A review of recent research confirms that psychopathy remains primarily a penal rather than medical condition. I conclude that focusing studies of medicalization on practice rather than discourse clarifies the concept and avoids reifying the notion of a medicalized society. (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 19thcentury 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)
A 62-year-old female with Huntington’s disease presented after a suicide attempt. Her advance directive stated that she did not want intubation or resuscitation, which her family acknowledged and supported. Despite these directives, she was resuscitated in the emergency department and continued to state that she would attempt suicide again. Her suicidality in the face of a chronic and advancing illness, and her prolonged consistency in her desire to take her own life, left careproviders wondering how to provide ethical, respectful care (...) to this patient. Tension between the ethical principles of autonomy and beneficence is central in this case. The patient’s narrative demonstrated that her suicide was an autonomous decision, free from coercion or disordered thinking from mental illness. Beneficence then would seem to necessitate care aligned with the patient’s desire to end her life, which created ethical uneasiness for her family and careproviders. The case highlights several end-of-life ethical considerations that have received much recent attention. With ongoing discussions about the legalization of aid in dying across the country, caregivers are challenged to understand what beneficence means in people with terminal illnesses who want a say in their death. This case also highlights the profound moral distress of families and careproviders that arises in such ethically challenging scenarios. (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)