The book aims to develop a new approach to philosophy of medicine. Much attention is paid to the relative merits of philosophical analysis in the Anglo-Saxon tradition, and phenomenology. Themes considered are cultural bias in philosophy of medicine, regular versus alternative medicine, concepts of health and disease, and the mind-body problem.

Philosophical theories about reduction and integration in science are at variance with what is happenign in science. A realistic approach to science show that possibilities for reduction and integration are limited. The classical ideal of a unified science has since long been rejected in philosophy. But the current emphasis on interdisciplinary integration in philosophy and in science shows that it survives in a different guise. It is necessary to redress the balance, specifically in biology. Methodological analysis shows that many of (...) the grand interdisciplinary theories involving biology actually represent pseudo-integration covered up by inappropriate, overgeneral concepts. Integrationism is not bad, but it must be kept within reasonable bounds. If the present analysis is appropriate, there will have to be fundamental changes in research strategy both in science and in the philosophy of science. (shrink)

Evolutionary psychology is put forward by its defenders as an extension of evolutionary biology, bringing psychology within the integrated causal chain of the hard sciences. It is extolled as a new paradigm for integrating psychology with the rest of science. We argue that such claims misrepresent the methods and explanations of evolutionary biology, and present a distorted view of the consequences that might be drawn from evolutionary biology for views of human nature. General theses about adaptation in biology are empty (...) schemata, not laws of nature allowing the subsumption of mind under biology. Functional thinking is an indispensable tool for psychology, mostly of value in abstractive unification and as a heuristic, but it gains little from association with evolutionary notions of selection. Thus, we argue, the cherished integrative causal model evaporates, and evolutionary phraseology serves no more than rhetorical purposes. Moreover, the universality of human nature and the evolutionary irrelevance of individual variation are presented as biological truths that psychologists should respect in their approach to mind. On closer inspection, this turns out to be rather dubious biology. Psychology might conceivably be better off as a continuation of biology by different means, but evolutionary psychology does not provide the conceptual integration leading to such a happy union. (shrink)

Methodological analysis shows that the concepts of fitness and adaptation are more complex than the literature suggests. Various arguments against ‘adaptationism’ are inadequate since they are couched in terms of unduly simplistic notions.

Grime in a recently developed theory distinguished three basic plant strategies: stress tolerance,ruderality and competition. He relates them to environments characterized in terms of stress and disturbance. Classifications of strategies and environments both are ultimately defined in terms of production. This tends to make the theory tautological. If the theory is to make sense, environments had better be defined in independent terms.

Various philosophers and evolutionary biologists have recently defended the thesis that species are individuals rather than sets. A decade of debates, however, did not suffice to settle the matter. Conceptual analysis shows that many of the key terms involved are ambiguous. Current disagreements should dissolve once this is recognized. Explication of the concepts involved leads to new programs for philosophical research. It could also help biology by showing how extant controversies concerning evolution may have conceptual rather than factual roots.

Is human behavior exclusively motivated by self-interest? Common sense indicates that we should flatly deny this, or so it seems to me. Yet the doctrine of universal self-interest, psychological egoism for short, has gained the support of many researchers in science. Common sense also seems to allow the rejection of ethical egoism, the doctrine that human behavior should be motivated exclusively by self-interest. It appears to be at variance with widely endorsed moralities. Yet it is a perennial subject of research (...) in ethics. What stance should we take in the face of these discrepancies? Two views suggest themselves. Commonsensical views of egoism and altruism are flawed or research on the subject in science and ethics is misguided. Considering ethics I argue in this article that research is misguided to the extent that it is conducted at inappropriately high levels of generality. I argue that both ethical egoism and psychological egoism are mistaken. (shrink)

Sober and Brandon et al. disagree about the role of screening-off in the appraisal of theories of natural selection. Some problems disregarded by them are unearthed in this discussion note.

Offers a practical philosophy of the life sciences, showing how scientific reasoning can, in limited contexts, be translated into the language of philosophy, and how science can correct the philosophy of science.

Science is not value-free and ethics is not fact-free. Science and ethics should be similar, but they are not. The author indicates how research in ethics is to change in the face of this. Ethicists should accommodate empirical work in their programs and they should take heed of methodologies developed in science and philosophy of science. They should abandon the search for a single overarching theory of morality. Controversies in ethics are often spurious for lack of articulate methodological key concepts. (...) For example, disagreements over the value of general theories are misguided since disputants implicitly use different notions of generality and different notions of theory. An appropriate methodology does not suffice for the resolution of controversies but it is indispensable for consensus. The book argues these theses in a general way and applies them to the subject of egoism and altruism in ethics. Further case studies concern the environment and psychiatric disorders. (shrink)

Peter Wenz has recently distinguished various forms of moral pluralism in an effort to dissolve the controversy over monism and pluralism. I argue that the distinctions are not really helpful once the methodology and the substance of science are brought to bear on ethics. Theories in ethics and science alike are subject to context-dependent methodological trade-offs. Hence, the category of theories should be heterogeneous. Monism and pluralism are at cross-purposes since they endorse different unanalyzed notions of theory. Awareness of heterogeneity (...) among theories is helpful in dismissing the controversy. (shrink)

Industrial melanism, according to the traditional explanation, amounts to niche construction since it involves changes in predation pressure. Indeed, it would be difficult to imagine selection without niche construction. This cannot be what Laland, Odling-Smee & Feldman mean. They offer convincing examples, but they should provide a better definition of “niche construction” to indicate how their view supplements traditional evolutionary biology.

Overmedication is nowadays a serious problem in health care due to influences from the pharmaceutical industry and agencies responsible for regulation. The situation has indeed become appalling in psychiatry, where both theories and treatments have deteriorated under the impact of the industry. The overmedication problem is associated with biased biology in medicine. Adequate biological approaches would indicate that drug therapies must yield to diet therapies, particularly treatments involving omega-3 fatty acids, in many cases. To the extent that philosophy of science (...) adapts to mainstream medicine in analyses of the current situation, it may reinforce the existing bias. To redress imbalances in health care, we ultimately have to rely on common sense. (shrink)

Sober and Brandon et al. disagree about the role of screening-off in the appraisal of theories of natural selection. Some problems disregarded by them are unearthed in this discussion note.

One of the major criticisms of optimal foraging theory is that it is not testable. In discussions of this criticism opposing parties have confused methodological concepts and used meaningless biological concepts. In this paper we discuss such misunderstandings and show that OFr has an empirically testable, and even well-confirmed, general core theory. One of our main conclusions is that specific model testing should not be aimed at ‘proving’ optimality, but rather at identifying the context in which certain types of behaviour (...) are optimal. To do this, it is necessary to be aware of the assumptions made in testing a model. The assumptions that are explicitly stated in the literature up to now do not completely cover the actual assumptions made in testing OFT models in practice. We present a more comprehensive set of assumptions. Although all the assumptions play a role in testing models, they are not of equal status. Crucial assumptions concern constraints and the relation between fitness and currency. Therefore, it is essential to make such assumptions testable in practice. We show that a more explicit relationship between OFT modelling and evolutionary theory can help with this. Specifically, phylogeny reconstruction and population dynamic modelling can and should be used to formulate assumptions concerning constraints and currencies. (shrink)

Biology incorporated into other disciplines is often distorted, alarmingly so in some areas of medicine. Together with other forms of bias, this may have detrimental effects for patients depending on medical research for their health. A case study concerning omeprazole (Losec), one of the acid-suppressive drugs against gastric ulcers, and NSAIDs, non-steroid anti-inflammatory drugs, confirms that distorted biology together with biased health care policies foster disasters in current biomedicine and medical practice. In our country, The Netherlands, omeprazole is presumably the (...) most commonly used medication. NSAIDs are also used in large quantities, increasingly since they have become available as analgesic over-the-counter drugs. Unofficial and official sources tend to inform the general public that the drugs promote human health. We argue that their being used on a massive scale is actually a medical disaster. The health of many patients would be served better if the drugs they take were replaced by proper forms of diet, but the pharmaceutical industry, the most potent force affecting medication policies, appears to prevent a shift in the balance from over-medicalization towards healthy life styles. The shift should come from government agencies responsible for regulation in the medication market. Policies of these agencies are now a dismal failure. (shrink)

Research in behaviour genetics uncovers causes of behaviour at the population level. For inferences about individuals we also need to know how genes and the environment affect phenotypes. Behaviour genetics fosters a biased view of individual behaviour since it identifies the environment with psychosocial factors and disregards ecology.

Something is wrong with current discussions about theory reduction. The question of whether higher level theories are reducible to lower level theories cannot be posed in a sensible way if methodological principles that are needed to evaluate scientific theories are disregarded. If this is recognized, the problem looses much of its alleged importance.

In this article a case is made for the importance of a previously overlooked phenomenon, physical empathy orcompathy,defined as the physical manifestation of caregiver distress that occurs in the presence of a patient in physical pain or distress. According to the similarity of a caregiver's response to the original symptoms, there can be four types of compathetic response: identical, initiated, transferred, and converted. Controlling for the compathetic response may involve narrowing one's focus and/or changing caregiver attitudes. Finally, we argue that (...) while the compathetic response may be beneficial to the caregiving relationship, enabling the provision of appropriate and adequate humane treatment and care, the caregiver must at times shield against the compathetic response in order to provide care. (shrink)

The impact of philosophy of science on biology is slight. Evolutionary biology, however, is nowadays an exception. The status of the neo-Darwinian theory of evolution is seriously challenged from a methodological perspective. However, the methodology used in the relevant discussions is plainly defective. A correct application of methodology to evolutionary theory leads to the following conclusions. The theory of natural selection is unfalsifiable in a strict sense of the term. This, however, does not militate against the theory, because no scientific (...) theory whatever is testable in this way. Under a more liberal testability criterion, the theory is surely testable. None the less, certain research programs may tend to make the theory untestable in practice. It has often been argued that the tautologous character of the principle of natural selection, allegedly the focus of evolutionary theory, makes the theory untestable through circular reasoning. Actually, the principle is only a tautology if ‘fitness’ is wrongly defined in terms of actual survival. But even then circular reasoning need not ensue. Evolutionary principles do not permit, without additional information, the derivation of statements about evolutionary events concerning particular species or populations. If this were a reason to criticize the theory , any other scientific theory would be inadequate by the same token. (shrink)

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients.The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health (...) and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians , the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a “checklist of considerations” . Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline . The accordingly adapted “checklist of considerations” was tested in a pilot study , after which all experts endorsed the checklist .The resulting “checklist of considerations” structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest. (shrink)

Chapter 1 Introduction The man was coughing again. Shocked he was as he discovered that his saliva had a reddish taint. Would he have a lung disease after all? Cancer perhaps? Long ago, relatives of his had died from LC, lung cancer.

Autoimmune diseases such as rheumatoid arthritis and gastrointestinal disorders such as stomach ulcers are often treated with drugs. NSAIDs, a common treatment in rheumatoid arthritis, may cause stomach ulcers which call for additional medications, notably antacids in the sense of drugs that suppress acid secretion by the stomach. Infection with Helicobacter pylori also plays a role in the ulcers. The infection is typically treated with antibiotics added to antacids. Considering NSAIDs and antacids, we suspect that overmedication is common to the (...) extent that particular diets are a better option. Current research and current treatments with these drugs are also problematic since circadian rhythms are mostly disregarded. All the processes involved in the disorders treated show marked variations in the course of the day. Hence experiments conforming to the guidelines of evidence-based medicine, and treatments in line with them, have outcomes strongly depending on the time factor. This calls for reforms in medicine with fresh inputs from biology. (shrink)

Rachlin provides an impressive integrative view of altruism and selfishness that helps us correct older views. He presents a highly general theory, even though he is aware of context-dependence of key notions, including altruism. The context-dependence should extend much farther than Rachlin allows it to go. We had better replace theoretical notions of altruism and selfishness by common sense.

Animal liberation ethics and environmental ethics have recently come of age. Concerning concrete moral rules considered by researchers in these areas there is much consensus. Highly general theories formulated to justify the rules are more problematic. However, the search for such theories may well be misguided.

Philosophy of medicine and its daughter bioethics seldom undertake a critical analysis of live medical science. That is a serious shortcoming since some forms of bias in medical science have a negative impact on health care. Most notably, many areas of medicine focus on a restricted area of biology to the exclusion of ecology. Ecological thinking should lead to fundamental changes in medicine and the philosophy of medicine.