In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

Why do people get sick? I argue that a disease explanation is best thought of as causal network instantiation, where a causal network describes the interrelations among multiple factors, and instantiation consists of observational or hypothetical assignment of factors to the patient whose disease is being explained. This paper first discusses inference from correlation to causation, integrating recent psychological discussions of causal reasoning with epidemiological approaches to understanding disease causation, particularly concerning ulcers and lung cancer. It then shows how causal (...) mechanisms represented by causal networks can contribute to reasoning involving correlation and causation. The understanding of causation and causal mechanisms provides the basis for a presentation of the causal network instantiation model of medical explanation. (shrink)

This paper is a criticalexamination of the development of thephilosophy of medicine as a discipline. Ithighlights two major themes in the contemporarydebate about the philosophy of medicine: thescope of the discipline and the relation of thediscipline to its cognate disciplines. A broadview of the philosophy of medicine is defendedand the philosophy of medicine is seen as aphilosophical sub-discipline. These viewsdepend in important ways on three factors: ageneral metaphysical world view, particularunderstandings of the cognate disciplines, andthe perspective from which one asks (...) thequestions about the nature of the discipline. It is proposed that the future of thephilosophy of medicine may follow thephilosophy of science in that philosophical,sociological and historical studies may combinein a mutually enriching way to form ‘‘medicinestudies.’‘. (shrink)

This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of illness narrative, an alternative phronesis approach to medical ethics influenced by Charles Taylor’s account of the interpretive nature of human agency and language is examined. To this end, the account of (...) interpretive medical responsibility previously described by Schultz and Carnevale as "clinical phronesis" (based upon Taylor’s notion of "strong" or "radical evaluation") is reviewed and expanded. The thesis of this paper is that illness narrative has the ability to benefit patients as well as the potential to cause harm or iatrogenic effects. This benefit or harm is contingent upon how the story is told and understood. Consequently, these tales are not simply "nice stories," cathartic gestures, or mere supplements to scientific procedures and decision making, as suggested by the objectivist approach. Rather, they open the agent to meanings that provide a context for explanation and evaluation of illness episodes and therapeutic activities. This understanding provides indicators (guides) for right action. Hence, medical responsibility as clinical phronesis involves, first, the patient and provider’s coformulation and cointerpretation of what is going on in the patient’s illness narrative, and second, the patient and provider’s response to interpretation of the facts of illness and what they signify–not simply a response to the brute facts of illness, alone. The appeal to medical responsibility as clinical phronesis thus underscores the importance of getting the patient’s story of illness right. It is anticipated that further elaboration concerning the idea of clinical phronesis as interpretive illness narrative will provide a new foundation for medical ethics and decision making. (shrink)

In a previous paper the concept of disease was fuzzy-logically analyzed and a sketch was given of a prototype resemblance theory of disease (Sadegh-Zadeh (2000). J. Med. Philos., 25:605–38). This theory is outlined in the present paper. It demonstrates what it means to say that the concept of disease is a nonclassical one and, therefore, not amenable to traditional methods of inquiry. The theory undertakes a reconstruction of disease as a category that in contradistinction to traditional views is not based (...) on a set of common features of its members, that is individual diseases, but on a few best examples of the category, called its prototypes, and a similarity relationship such that a human condition is considered a disease if it resembles a prototype. It enables new approaches to resolving many of the stubborn problems associated with the concept of disease. (shrink)

The notions of health, illness, and disease are fuzzy-theoretically analyzed. They present themselves as non-Aristotelian concepts violating basic principles of classical logic. A recursive scheme for defining the controversial notion of disease is proposed that also supports a concept of fuzzy disease. A sketch is given of the prototype resemblance theory of disease.

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that medicine is (at least (...) in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

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

The purpose of this paper is to analyze the structure and the defeasibility conditions of argument from analogy, addressing the issues of determining the nature of the comparison underlying the analogy and the types of inferences justifying the conclusion. In the dialectical tradition, different forms of similarity were distinguished and related to the possible inferences that can be drawn from them. The kinds of similarity can be divided into four categories, depending on whether they represent fundamental semantic features of the (...) terms of the comparison or non-semantic ones, indicating possible characteristics of the referents. Such distinct types of similarity characterize different kinds of analogical arguments, all based on a similar general structure, in which a common genus is abstracted. Depending on the nature of the abstracted common feature, different rules of inference will apply, guaranteeing the attribution of the analogical predicate to the genus and to the primary subject. This analysis of similarity and the relationship thereof with the rules of inference allows a deeper investigation of the defeasibility conditions. (shrink)

ABSTRACT: In this essay I characterize arguments by analogy, which have an impor- tant role both in philosophical and everyday reasoning. Arguments by analogy are dif- ferent from ordinary inductive or deductive arguments and have their own distinct features. I try to characterize the structure and function of these arguments. It is further discussed that some arguments, which are not explicit arguments by analogy, nevertheless should be interpreted as such and not as inductive or deductive arguments. The result is that (...) a presumed outcome of a philosophical dispute will have to be reconsidered. (shrink)

Clinical medicine is the application of scientific principles, rules of thumb, and a store of practical wisdom embodied in narratives of individual cases to the care of a person who is ill. Physicians are taught to observe and report the individual case both as a means of fitting nomothetic generalizations to the given circumstances and as a way of refining those generalizations. This narrative construction of illness is a principal way of knowing in medicine. In this view, disease is not (...) so much an entity as an identifiable chronological organization of the events of illness, and medicine, rather than a science, a rational science-using activity in the service of the ill. Keywords: medical epistemology, casuistry, clinical judgment, narrative CiteULike Connotea Del.icio.us What's this? (shrink)

Philosophical debates about the concept of disease, particularly of mental disease, might benefit from reconsideration and a closer look at the established terminology and conceptual structure of contemporary medical pathology and clinical nosology. The concepts and principles of medicine differ, to a considerable extent, from the ideas and notions of philosophical theories of disease. In medical theory, the concepts of disease entity and pathologicity are, besides the concept of disease itself, of fundamental importance, and they are essentially connected to the (...) concepts cause of disease or etiological factor, natural course or natural history of disease, and pathological disposition. It is the concept of disease entity that is of key importance for understanding medical pathology and theory of disease. Its central role is shown by a short reconstruction of its main features and its intrinsic connection to the concept of pathologicity. The meaning of pathologicity is elucidated by explicating the underlying criteria. (shrink)

Translation of Frege's 'Über Begriff und Gegenstand' (1892). Translation by Peter Geach, revised by Max Black.

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry. The main claims are as follows: 1. The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles. 2. Elements from the normative and naturalistic definitions of disease are necessary (...) for a thorough definition that dodges common objections to either. 3. Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine. The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles. Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that dodges common objections to either. Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine. Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically. (shrink)

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry.The main claims are as follows:1.The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles.2.Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that (...) dodges common objections to either.3.Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine.Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

The world’s scientific community must be in a state of constant readiness to address the threat posed by newly emerging infectious diseases. Whether the disease in question is SARS in humans or BSE in animals, scientists must be able to put into action various disease containment measures when everything from the causative pathogen to route(s) of transmission is essentially uncertain. A robust epistemic framework, which will inform decision-making, is required under such conditions of uncertainty. I will argue that this framework (...) should have reasoning at its center and, specifically, that forms of reasoning beyond deduction and induction should be countenanced by scientists who are confronted with emerging infectious diseases. In previous articles, I have presented a case for treating certain so-called traditional informal fallacies as rationally acceptable forms of argument that can facilitate scientific inquiry when little is known about an emerging disease. In this article, I want to extend that analysis by highlighting the unique features of these arguments that makes them specially adapted to cope with conditions of uncertainty. Of course, such a view of the informal fallacies must at least be consistent with the reasoning practices of scientists, and particularly those scientists (viz. epidemiologists) whose task it is to track and respond to newly emerging infectious diseases. To this end, I draw upon examples of scientific reasoning from the UK’s BSE crisis, a crisis that posed a significant threat to both human and animal health. (shrink)

Few, if any, scientific inquiries are conducted against a background of complete knowledge, a background in which inquirers are in possession of the ‘full facts’ that relate to a particular question or issue. More often than not, scientists are compelled to conduct their deliberations in contexts of epistemic uncertainty, in which partial knowledge or even a total absence of knowledge characterise inquiry. Nowhere is this epistemic uncertainty more evident, or indeed more successfully controlled, than in the branch of scientific inquiry (...) called epidemiology. In this paper, I examine how epidemiologists overcome the unique challenges to inquiry that are posed by epistemic uncertainty. In specific terms, I contend that epidemiologists employ analogical reasoning strategies in an attempt to advance their inquiries in situations that are epistemically uncertain. The context for my claims will be the early inquiries that were conducted into the emergence of HIV/AIDS in the United States. I argue that early scientific work in relation to HIV/AIDS was directly premised upon epidemiological investigations in which analogical reasoning with hepatitis B had featured significantly. I conclude that epidemiological investigations of AIDS exemplify the capacity of analogical reasoning to advance inquiry under conditions of epistemic uncertainty. To this extent, analogical reasoning should be a concern both to those who address practical problems of uncertainty management and to those who pursue theoretical debates within argumenta-tion studies and epistemology. (shrink)

Few, if any, scientific inquiries are conducted against a background of complete knowledge, a background in which inquirers are in possession of the ‘full facts’ that relate to a particular question or issue. More often than not, scientists are compelled to conduct their deliberations in contexts of epistemic uncertainty, in which partial knowledge or even a total absence of knowledge characterise inquiry. Nowhere is this epistemic uncertainty more evident, or indeed more successfully controlled, than in the branch of scientific inquiry (...) called epidemiology. In this paper, I examine how epidemiologists overcome the unique challenges to inquiry that are posed by epistemic uncertainty. In specific terms, I contend that epidemiologists employ analogical reasoning strategies in an attempt to advance their inquiries in situations that are epistemically uncertain. The context for my claims will be the early inquiries that were conducted into the emergence of HIV/AIDS in the United States. I argue that early scientific work in relation to HIV/AIDS was directly premised upon epidemiological investigations in which analogical reasoning with hepatitis B had featured significantly. I conclude that epidemiological investigations of AIDS exemplify the capacity of analogical reasoning to advance inquiry under conditions of epistemic uncertainty. To this extent, analogical reasoning should be a concern both to those who address practical problems of uncertainty management and to those who pursue theoretical debates within argumentation studies and epistemology. (shrink)

What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this “curative thesis” is not satisfactory, even when “cure” is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Moreover, the efficacy of medicine (...) for improving population health has been famously doubted by historians and epidemiologists. The curative thesis demands that we have mostly been stupid, duped, or staggeringly hopeful, given that medicine has not until recently offered more than a handful of effective cures. I suggest, in this article, that the core medical competence is neither to cure, nor to prevent, disease, but to understand and to predict it. I argue that this approach does a better job than the curative thesis at explaining why not all medicine is concerned with curative efforts and that it enjoys historical support from the ancient entanglement of prophecy and medicine and from the fact that medicine thrived for centuries with almost no effective cures and continues to thrive today in various forms that are mostly without curative efficacy. I suggest that this approach grounds a fairer approach to alternative, traditional, and other medical practices, as well as some fresh lessons for the development of mainstream medicine. (shrink)

Analogies must be symmetric. If a is like b, then b is like a. So if a has property R, and if R is within the scope of the analogy, then b (probably) has R. However, analogical arguments generally single out, or depend upon, only one of a or b to serve as the basis for the inference. In this respect, analogical arguments are directed by an asymmetry. I defend the importance of this neglected – even when explicitly mentioned – (...) feature in understanding analogical arguments. (shrink)

The book also comes with an exhaustive array of study aids that enable the reader to monitor and enhance the learning process.

Although fallacies have been common since Aristotle, until recently little attention has been devoted to identifying and defining them. Furthermore, the concept of fallacy itself has lacked a sufficiently clear meaning to make it a useful tool for evaluating arguments. Douglas Walton takes a new analytical look at the concept of fallacy and presents an up-to-date analysis of its usefulness for argumentation studies. Walton uses case studies illustrating familiar arguments and tricky deceptions in everyday conversation where the charge of fallaciousness (...) is at issue. The numerous case studies show in concrete terms many practical aspects of how to use textual evidence to identify and analyze fallacies and to evaluate arguments as fallacious. Walton looks at how an argument is used in the context of conversation. He defines a fallacy as a conversational move, or sequence of moves, that is supposed to be an argument that contributes to the purpose of the conversation but in reality interferes with it. The view is a pragmatic one, based on the assumption that when people argue, they do so in a context of dialogue, a conventionalized normative framework that is goal-directed. Such a contextual framework is shown to be crucial in determining whether an argument has been used correctly. Walton also shows how examples of fallacies given in the logic textbooks characteristically turn out to be variants of reasonable, even if defeasible or questionable arguments, based on presumptive reasoning. This is the essence of the evaluation problem. A key thesis of the book, which must not be taken for granted as previous textbooks have so often done, is that you can spot a fallacy from how it was used in a context of dialogue. This is an innovative and even, as Walton notes, "a radical and controversial" theory of fallacy. (shrink)

"This is a wonderful book! In "How Scientists Explain Disease," Paul Thagard offers us a delightful essay combining science, its history, philosophy, and sociology.

This volume covers a wide range of conceptual, epistemological and methodological issues in the philosophy of science raised by reflection upon medical science and practice.

A comprehensive introduction to current research on the psychology of concept formation and use.

Keith Holyoak and Paul Thagard provide a unified, comprehensive account of the diverse operations and applications of analogy, including problem solving, ...

New concepts are constantly being introduced into our thinking. Conceptual Systems explores how these new concepts are entered into our systems along with sufficient continuity with older ideas to ensure understanding. The encyclopaedic breadth of this text highlights the many different aspects and disciplines that together present an insightful view into the various theories of concepts. Harold Brown, a reputable author in the philosophy of science examines several historically influential theories of concepts as well as providing a clear view on (...) the general theory of conceptual change. Interesting case studies examine examples of conceptual change in the history of physics including the move in seventeenth century physics from Galileo to Descates to Newton; and the conceptual framework of the "standard model" in the late twentieth century high- energy physics. The key central themes in the philosophy of science that are explored in- depth in this enormous book make it an essential read for academics in this field. (shrink)

In this entry, Frege's logic is introduced and described in some detail. It is shown how the Dedekind-Peano axioms for number theory can be derived from a consistent fragment of Frege's logic, with Hume's Principle replacing Basic Law V.

This entry explains Frege's Theorem by using the modern notation of the predicate calculus. Frege's Theorem is that the Dedekind-Peano axioms for number theory are derivable from Hume's Principle, given the axioms and rules of second-order logic. Frege's methodology for defining the natural numbers and for the derivation of the Dedekind-Peano axioms are sketched in some detail.

The reasoning process of analogy is characterized by a strict interdependence between a process of abstraction of a common feature and the transfer of an attribute of the Analogue to the Primary Subject. The first reasoning step is regarded as an abstraction of a generic characteristic that is relevant for the attribution of the predicate. The abstracted feature can be considered from a logic-semantic perspective as a functional genus, in the sense that it is contextually essential for the attribution of (...) the predicate, i.e. that is pragmatically fundamental (i.e. relevant) for the predica-tion, or rather the achievement of the communicative intention. While the transfer of the predicate from the Analogue to the analogical genus and from the genus to the Primary Subject is guaranteed by the maxims (or rules of inference) governing the genus-species relation, the connection between the genus and the predicate can be complex, characterized by various types of reasoning patterns. The relevance relation can hide implicit arguments, such as an implicit argument from classification , an evaluation based on values, consequences or rules, a causal relation, or an argument from practical reasoning. (shrink)

In a doctor-linguist collaboration, a framework of reasoning in clinical contexts is presented. Arguments used for inquiry, justification and persuasion are sketched in diagnosis, counselling, and management settings integral to everyday clinical practice thereby extending the diagnostic function typically associated with clinical reasoning per se. A system of logic, a method of persuasive orientation, and a synthesis of negotiation in dialogue are then elaborated to illustrate the complexity of argument practice in medical culture.

Six experiments explored the hypothesis that the members of categories which are considered most prototypical are those with most attributes in common with other members of the category and least attributes in common with other categories. In probabilistic terms, the hypothesis is that prototypicality is a function of the total cue validity of the attributes of items. In Experiments 1 and 3, subjects listed attributes for members of semantic categories which had been previously rated for degree of prototypicality. High positive (...) correlations were obtained between those ratings and the extent of distribution of an item's attributes among the other items of the category. In Experiments 2 and 4, subjects listed superordinates of category members and listed attributes of members of contrasting categories. Negative correlations were obtained between prototypicality and superordinates other than the category in question and between prototypicality and an item's possession of attributes possessed by members of contrasting categories. Experiments 5 and 6 used artificial categories and showed that family resemblance within categories and lack of overlap of elements with contrasting categories were correlated with ease of learning, reaction time in identifying an item after learning, and rating of prototypicality of an item. It is argued that family resemblance offers an alternative to criterial features in defining categories. (shrink)

The terms health, disease and illness are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the disease concept is illusory. The health/disease distinction is irrelevant for (...) most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease. (shrink)

The terms "health", "disease" and "illness" are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the 'disease' concept is illusory. The health/disease distinction is irrelevant for (...) most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease. (shrink)

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as (...) to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. (shrink)

Caplan has argued that the philosophy of medicine does not exist. Although I will not deny the points he makes, I will argue that the philosophy of medicine has characteristics of a developing field with the potential to meet all of Caplan's criteria. The argument is based on Dewey's established views on logical development for a field of inquiry, as well as pointing out how other criteria Caplan imposes can be fulfilled.