Health

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)

Throughout the 19th century and early decades of the 20th century, milk was a dangerous food that required state intervention to make it safe. Throughout this period, the germ theory of contagious disease came to prominence, but could not explicitly determine the causal relationships linking germs, milk, and human illness. Using the notion of an ideational regime, I examine how (1) knowledge claims move from uncertainty to certainty and become privileged claims within ideational regimes that (2) result in an unintended, (...) but necessary deployment of a biopolitical strategy for governance. The argument here is that theoretical uncertainty meant managing populations as a uniform undifferentiated reality using pasteurization technologies. I use two historical moments as evidence of these processes. The first is the 1901 British Congress on Tuberculosis when I argue germ theory came to a theoretical standstill and the second is Ontario’s 1938 amendment to the province’s Public Health Act that permanently institutionalised province-wide compulsory pasteurisation laws organised around the notion of nutritional equivalency. This genealogical exploration should provide some insight into how bacteria became the singular cause of illness and into the conditions that led to targeting milk as the main site of intervention instead of treating individual bodies. (shrink)

Various historical sources from the Renaissance--including transcripts of trials for witchcraft, writings on demonology and textbooks of pharmaceutical botany--describe vegetal ointments prepared by women accused of witchcraft and endowed with marked psychoactive properties. Here, we examine the botanical composition and the possible pharmacological actions of these ointments. The results of our study suggest that recipes for narcotic and mind-altering salves were known to Renaissance folk healers, and were in part distinct from homologous preparations of educated medicine. In addition, our study (...) reveals an unexpected connection of these vegetal psychotropes with archaic chtonic beliefs, confirming the tight association between rituals and cults entered on the Underworld and the image of the Medieval witch. (shrink)

The main objective of this paper is to introduce the concept of the “animal patient” to academic debates on animal ethics, veterinary ethics and medical ethics. This move reflects the prioritization of the animal patient in the veterinary profession’s own current ethical self-conception. Our paper contributes to the state of research by analysing the conceptual prerequisites for the constitution and understanding of animals as patients through the lens of two concepts fundamental to the medical field: health and disease. The first (...) section describes, how these concepts are inextricably entangled with the animal’s becoming a patient. The understanding of health and disease, we determine, has a great impact on the actual treatment of animals as patients. We show that a naturalistic perspective on health and disease still prevails in the veterinary field. By contrast, we use a historical study to demonstrate how a socio-historical perspective on animal diseases enriches our understanding of veterinary practice and its ethical dimensions. This perspective will prove not only able to deal with the wide variety of veterinary patients, but also to release underlying normative processes to ethical reflection and research. We elaborate on that assertion by spelling out the constructive dimension between the veterinary gaze and the objects of its experience. The final section brings veterinary medicine’s ethical relationship to the animal patient into the picture. The discipline is guided by an ethical principle of advocacy, defined as the responsibility to recognise and defend the animal patient’s interest in health. Our principle conclusion is that ethical philosophical thinking on interactions between specific notions of health and disease and animal patients makes a substantial contribution to surmounting this moral challenge. As ‘health’ and ‘disease’ determine the options for the articulation of an animal patient’s interest, investigation into the ever-changing and particular conceptualisations of these notions fosters its recognition. We conclude with a prospect resulting from those theoretical insights: meeting the animal patient’s interest could furthermore mean seeking an articulation of the specific interactions between concrete, living animal patients and veterinary concepts. (shrink)

The influence of Kurt Goldstein on the thinking of Georges Canguilhem extended throughout his entire work. This paper seeks to examine this relationship in order to conduct a study of the norm as a nexus or connection between the concept and life. Consequently, this work will be a reflection on the approach to life as a normative activity and self-realization. For this, it will be necessary to redefine the concepts of health and disease, and make a crossover between the two. (...) At the end of this trajectory, it will be found that these concepts can explain the identity between the concept and life, which leads to the unexpected conclusion that the cure is ultimately self-healing. (shrink)

Hynek Bartos does the field of ancient philosophy a great service by detailing the influence of early Greek thinkers (such as Heraclitus, Empedocles, Anaxagoras, Democritus, and Diogenes of Apollonia) on the Hippocratic work On Regimen, and by demonstrating that work’s innovative engagement with contemporary scientific and philosophical concepts as well as its direct influence on Plato and Aristotle. His study usefully counteracts the lamentable tendency among ancient philosophers to ignore or downplay the influence of medical literature on philosophy in general, (...) and to heap scorn on this text in particular, which Kirk, Raven, and Schofield considered ‘an eclectic and very superficial quasi- philosophical treatise’ and Barnes famously called ‘a silly farrago of ill-digested Presocratic opinions’. (shrink)

Purpose: The purpose of this study was to evaluate the veracity of a theoretically derived model of health that describes a non-linear trajectory of health from birth to death with available population data sets. Methods: The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoretically derived non-linear health model predictions, (...) using both qualitative approaches and quantitative one-sample Kolmogorov–Smirnov analysis with Monte Carlo simulation. Results: The mortality data's inverse resembles a log–normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log–normal distribution, supporting the underlying model assumptions. Post hoc manipulation showed the model predictions to be stable. Conclusions: This is a first theory of health to be validated by proxy data, namely the inverse of all-cause mortality. This non-linear model, derived from the notion of the interaction of physical, environmental, mental, emotional, social and sense-making domains of health, gives physicians a more rigorous basis to direct health care services and resources away from disease-focused elder care towards broad-based biopsychosocial interventions earlier in life. (shrink)

The germs of the ideas in this book became implanted in me during my experience as a resident in clinical pathology at Boston University Medical Center. At the time, I had inklings that the test results churned out by our laboratories were more than scientific facts. As a philosophically unsophisticated young physician, however, I had no language or framework to analyze what I saw as a deep philosophical problem, a problem largely unrecognized by most physicians. The test results provided by (...) our laboratories were accurate and of great practical importance for patient care. However, most of the physicians who relied on our test results to diagnose and treat their patients either did not have the time or interest to consider the philosophical issues inherent in diagnosis, or, like me, had inadequate means to further analyze them. It was more than ten years later that I began doctoral studies in philosophy, and I was fortunate to find a faculty that was supportive of my efforts to address the problem. This book began as my doctoral dissertation in the Department of Philosophy at Georgetown University. I would like to acknowledge the assistance of my mentor, Robert Veatch, Ph. D. Our conversations during my Georgetown years led me in new and often fascinating directions. I would also like to acknowledge the help of Kenneth Schaffner, M. D. , Ph. D. (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)

The “One Health” initiative promises to combine different health-related issues concerning humans and animals in an overarching concept and in related practices to the benefit of both humans and animals. Far from dismissing One Health, this paper nevertheless argues that different veterinary interventions are determined by social practices and connected expectations and are, thus, hardly compliant with only one single conceptualization of health, as the One Health concept suggests. One Health relies on a naturalistic understanding of health focusing on similar (...) bodies that show a similar etiology. However, logics, normativity, and practices exhibit differences when it comes to combatting infectious diseases, maintaining productivity of livestock animals or preventing companion animals from suffering. Therefore, drawing from Charles Rosenberg’s groundbreaking texts on framing disease, we suggest to conceive of health as dispersed in different frames. Thus, this paper proposes to interpret health as complex and multi-layered concept. We distinguish and introduce an objectivist, a functional, and a sentientistic frame of health. Instead of reducing the differential veterinary practices to one paradigmatic understanding, health is seen as a model case of Wittgenstein’s concept of family resemblance. Different and distinct perspectives on veterinary medicine show sufficient overlapping that allows for a common conceptualization, but there is not one single underlying logic suitable to understand and ethically reflect all veterinary interventions. This differentiability promises to reduce moral stress in veterinary professionals since it allows the interpretation of various, seemingly contradicting practices as dependent on multi-layered and socially determined scopes of responsibility. (shrink)

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

This is a book that is much easier to read than to review. For its originality and charm lie chiefly in the luminous, lively style and the choice of illustrative material garnered with great skill from an impressive array of authors ancient and modern. In these respects this long essay, which is as much philosophical and literary as scientific, is clearly in the distinguished tradition of French critical and philosophical writing although the language is English. It is easy to imagine (...) the shades of Montaigne, of the seventeenth-century Encyclopedists, of Renan, of Claude Bernard hovering in the corners of the author's study as he wrote. The two major theses conform also with the classical French essay. The first is a denial ofthe possibility of utopias—past, present, or future—and the corollary affirmation, "Complete freedom from disease and from struggle is almost incompatible with the process of living." As support is marshalled for this premise, the second is soon developed: While man cannot hope to refashion and dwell forever in a new Garden of Eden, he may, if he uses wisely all his intellectual and emotional resources, look forward to bettering his condition to such a degree that he may approximate at least for a time a true state of health and happiness. (shrink)

By means of a survey of Thoreau's writings, this article analyses his thoughts on health, emphasising some features that fit well with contemporary debates in the philosophy of medicine. Thoreau understands health as an environmental value, one that cannot be achieved without a personal relation to nature, but he does not provide a static definition of health within a fixed hierarchy of values. Thus he avoids a certain degree of essentialism that, when imposed on his work, makes it seem more (...) utopian and anti-scientific than it really is. The meaning of health for Thoreau is often contradictory and hard to disambiguate, and his context was different in many respects to ours, but his ideas on this topic still serve to criticise some of modern medicine's views on health and disease, and to steer it towards a more environmentally-informed approach to these phenomena. (shrink)

"Every man has his particular way of being in good health" - Emanuel Kant. Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well-being’. It is odd to define ‘health’ as (...) a negative state that puts it beyond the reach of everyone. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. (shrink)

In the present paper it is argued that genetic interventions on human embryos are in principle permissible if they promote the health of the persons that these embryos will one day become and impermissible if they compromise their health. This so called health-intervention principle is reached by, inter alia, rejecting alternative approaches to the problem of the permissibility of genetic intervention. The health-intervention principle can be interpreted in different ways depending on how the notion of health is understood. The central (...) part of the paper is an attempt to find a concept of health which is such that it makes the health-intervention principle normatively plausible. For this purpose I examine two influential competing theories of health: Cristopher Boorse’s biostatistical theory of health and Lennart Nordenfelt’s welfare theory of health. I argue that the health-intervention principle is more plausible if health is understood in the latter sense, although it is not ruled out that the principle may be given an even more plausible explication in terms of some other notion of health. (shrink)

The first part of this article shows that oureffective means to know and modify directly thehuman genetic make-up generates singular anddifficult situations for the application offundamental medical categories. Specifically,we demonstrate that in dealing with thesesituations, some predominant views on health,such as descriptivism or that which reduces thestate of health to not having presentdisabilities, cannot provide adequate answerseither from the point of view of medicalscience or in terms of our ordinary intuitions.The second part of the article examines thereasons for the failure (...) of these views totackle the mentioned situations, proposessolutions to urgent problems and, finally,offers some foundations for an alternativetheoretical development, id est, for atheory of health able to satisfactorilyintegrate our genetic dimension. (shrink)

The purpose of this paper is to give an explication of the concept of health which does not rely on the concept of disease. The explication is informed by a view of the human individual as an acting subject and it therefore places the abilities of agents in the centre. Abilities may be qualified in different ways. The qualification essential for understanding the dimension of health and illness relates abilities to environmental circumstances and high-ranking projects in the life plan. For (...) this purpose generalized adaptedness is introduced as the overarching construction. The dimension of health and illness is characterized in terms of the adequacy of the repertoire for generalized adaptedness. Some immediate consequences concerning the notion of care are noted. (shrink)

This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

This study aims to examine the public's knowledge and perceptions of connected health (CH).

The extent to which best practice for falls prevention is being routinely delivered by health care providers for community‐dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized health care for people at high risk of hospitalization.

Classification of patients with back pain in order to inform treatments is a long‐standing aim in medicine. We used latent class analysis (LCA) to classify patients with low back pain and investigate whether different classes responded differently to a cognitive behavioural intervention. The objective was to provide additional guidance on the use of cognitive behavioural therapy to both patients and clinicians.