This article focuses on the assessment of mechanistic relations with specific attention to medicine, where mechanistic models are widely employed. I first survey recent contributions in the philosophical literature on mechanistic causation, and then take issue with Federica Russo and Jon Williamson’s thesis that two types of evidence, probabilistic and mechanistic, are at stake in the health sciences. I argue instead that a distinction should be drawn between previously acquired knowledge of mechanisms and yet-to-be-discovered knowledge of mechanisms and that both (...) probabilistic evidence and manipulation are essential with respect to newly discovered mechanisms. (shrink)

This contribution claims that the two fundamental notions of causation at work in the health sciences are manipulative and mechanistic, and investigates what kinds of evidence matter for the assessment of causal relations. This article is a development of our 2007 article, ‘Plurality of Causality’, where we argue for a pluralistic account of causation with an eye to econometrics and a single medical example. The present contribution has a wider focus, and considers the notion of evidence within a whole range (...) of disciplines belonging to the health sciences. Section 1 addresses the relations between kinds of evidence and causal accounts, and it is shown how different notions of causation can be employed in various medical cases. Section 2 calls attention to issues crucial for any adequate epistemological theory of causation, such as the distinctions between types and tokens, observational and experimental regimes, explanation and prediction. Lastly, the notion of context is articulated, highlighted in its role in the assessment of causal links. All these issues are tackled in the framework of what we label a ‘bottom–up’ epistemology. (shrink)

The notion of causal evidence in medicine has been the subject of wide philosophical debate in recent years. The notion of evidence has been discussed mostly in connection with Evidence Based Medicine and, more in general, with the assessment of causal nexus in medical, and especially research contexts. “Manipulative evidence” is one of the notions of causal evidence that has stimulated much debate. It has been defined in slightly different ways, attributed different relevance, and recently placed at the core of (...) Gillies’ “action-related theory of causality”, a view specifically meant to address causation in medicine. While in general sympathetic to Gillies’ account, and totally convinced of the relevance of manipulative evidence and different sorts of interventions in the biomedical sciences, we believe that some further qualifications are needed to allow the notion of manipulative evidence to better express features of medical practice. In particular, we provide some qualification of the role of “interventional evidence” proposed by Gillies, suggesting a distinction between “interventional evidence” and “evidence for interventions”. A case study from research on rare diseases is analyzed in depth and a multifaceted notion of manipulative evidence put forward that allows better understanding of what manipulations in medical contexts amount to and what their targets are. (shrink)

In the last few years, avatars have been increasingly used in treating persistent persecutory auditory verbal hallucinations. The digital representation (an avatar) of persecutory hallucinations is voiced by the therapist and engages the patient in a dialogue, progressively conceding its power and, hence, reducing the stress experienced by the patient. Such attempts at integrating digital representations and cognitive behavior therapy raise a range of philosophical questions, which this chapter tackles along two trajectories. From an epistemological standpoint, we inquire what notion (...) of mental disorder can underlie the use of avatar therapy, and how our understanding of psychiatric diseases can be affected by the implementation of such a therapy. Relatedly, from an ethical standpoint, we reflect on some of the controversial issues posed by such therapeutic strategies. Discussing selected epistemological and ethical aspects stemming from the latest relevant literature both in philosophy and in psychiatry, the chapter aims to provide a tentative evaluation of trade-offs between the promises of and the limits to this therapeutic option. (shrink)

: This contribution aims to address epistemological issues at the crossroads of philosophy of science and psychiatry by reflecting on the notions of organization and resilience. Referring to the debate on the notion of “organization” and its explanatory relevance in philosophical neo-mechanistic theories, I consider how such positions hold up when tentatively applied to the mental health context. More specifically, I show how reflections on psychiatric resilience, cognitive reserve, and accommodation strategies challenge attempts to embrace a mechanistic perspective on mental (...) disorders. A deeper focus on these aspects of mental health is relevant to theoretical discussions on explanatory models as well as for clinical practice, diagnosis, and treatment. Keywords: Psychiatric resilience; Cognitive Reserve; Organization; Mechanism Il ruolo esplicativo dell’organizzazione e la resilienza psichiatrica: sfide ad un approccio meccanicistico alla malattia mentale Riassunto: Questo articolo intende discutere alcuni temi epistemologici all’incrocio tra la filosofia della scienza e la psichiatria, riflettendo sulle nozioni di organizzazione e resilienza. Muovendo dalle riflessioni sulla nozione di “organizzazione” sviluppate nell’ambito delle teorie neo-meccaniciste, e dalla difesa del suo ruolo esplicativo, il lavoro analizza la possibilità di estendere alcune posizioni relative alla spiegazione scientifica al contesto delle scienze della salute mentale. Più nello specifico, si illustra come le indagini sulla resilienza psichiatrica, la riserva cognitiva e le strategie di compensazione possano mettere in discussione i tentativi di abbracciare una prospettiva meccanicistica quando si affronta il tema del disturbo psichiatrico. Una maggiore attenzione ai suddetti filoni di ricerca può avere un impatto significativo sia sulla discussione relativa ai modelli teorici di spiegazione della malattia mentale sia sui processi clinici di diagnosi e terapia. Parole chiave: Resilienza psichiatrica; Riserva cognitiva; Organizzazione; Meccanicismo. (shrink)

Reductionism and antireductionism are among the most largely and hotly debated topics in philosophy of biology today. In this section of the volume, aiming to convey the current situation in the philosophy of the natural and life sciences, these topics are specifically addressed in Mehmet Elgin’s paper, focusing on biochemistry. Elgin strongly supports reductionism, first by claiming that the now classical argument based on multiple realizability does not entail anti-reductionism and secondly highlighting how the version of methodological reductionism that biochemistry (...) has been adopting – centered on “the principle that biological functions of biomolecules in living cells can be understood in terms of chemical and physical properties of those molecules”1 – has proved largely successful, teaching “us new knowledge about the biological systems”. Taken together, these two arguments are deemed to provide good grounds for a thorough defence of reductionism. While Elgin chooses biochemistry as his privileged standpoint on the issue, I shall dwell on the stances emerging in the health sciences. Although the health sciences are closely intertwined with – amongst others – biology and biochemistry, they also have their own peculiar features. Referring to some examples taken from different medical disciplines, I will question whether reductionism can be regarded as not only a viable, option, but as the best solution to gain new knowledge about biomedical systems. I shall suggest that considerations arising from current medical research and practice support a pluralistic approach to the topic, in which both reductionist and antireductionist stances can be accommodated in different ways. (shrink)

Much of the recent philosophical debate on causation and causal explanation in the biological and biomedical sciences has focused on the notion of mechanism. Mechanisms, their nature and epistemic roles have been tackled by a range of so-called neo-mechanistic theories, and widely discussed. Without denying the merits of this approach, our paper aims to show how lately it has failed to give proper credit to processes, which are central to the field, especially of contemporary molecular biology. Processes can be summed (...) up in the notion of ‘pathway’, which is far from being just equivalent to that of ‘mechanism’ and has a profound epistemological and explanatory relevance. It is argued that an adequate consideration of pathways impels some rethinking of scientific explanation in molecular biology, namely its functional and contextual features. A number of examples are given to suggest that the focus of philosophical attention in this disciplinary field should shift from the notion of mechanism to the notion of pathway. (shrink)

According to N. Goodman, the Carnapian notion of similarity is useless in science and without interest for philosophy. In our paper we suggest that, given the current role that the notion of similarity has in managing biomedical big data, this drastic position should be revised, and similarity should be provided a scientifically useful philosophical interpretation. With the advent of the new sequencing technologies, imaging technologies and with the improvements of health records, the number of genomics, post-genomics and clinical data has (...) exponentially increased. The deluge of data has urged, among others, to devise a new way of stratifying patients. A solution has been found and it is based exactly on the notion of similarity. By discussing two examples focusing on similarity among breast cancer patients, in the paper we illustrate such a use, and analyze it from a philosophical standpoint by resorting to A. Tversky’s features matching approach. We believe that the latter can foster some better understanding of the meaning and current use of similarity in the context of biomedical big data, and that, therefore, be the focus of further reflections in the philosophy of science, in particular in the philosophy of biomedicine. (shrink)

Following recent debate on the relations between philosophy of science and the sciences, we wish to draw attention to some actual ways of training both young philosophers of science and young life scientists and clinicians. First, we recall a successful case of training philosophers of the life sciences in a strictly scientific environment. Second, after a brief review of the reasons why life scientists and clinicians are currently asking for more ethics, more methodology of science, and more philosophy of science (...) in the training of life scientists and clinicians, we present two training models that could spur the discussion on how to meet the requests coming from the scientific community. We argue that in order to reflect on mutual relations between philosophy of science and the sciences and to foster proper interactions, issues regarding the topics considered, the features of educational curricula, and the institutional organizations should be addressed jointly. (shrink)

In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test—support or criticize—the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on (...) cancer research and neuropsychiatry. It jointly considers fields, which are usually dealt with separately, and keeps a close eye on scientific practice. The article has a twofold aim. First, it shows that identification of the explananda is a key issue when looking at dynamic processes and their implications in medical research and clinical practice. Second, it discusses the relevance of organizational accounts of mechanisms, and questions whether thorough self-sustaining mechanistic explanations can actually be provided when addressing cancer and psychiatric diseases. While acknowledging the merits of the wide ongoing debate on mechanistic models, the article challenges the mechanistic approach to explanation by discussing, in particular, explanatory and conceptual terms in the light of stances from medical cases. (shrink)

Complexity and integration are longstanding widely debated issues in philosophy of science and recent contributions have largely focused on biology and biomedicine. This paper specifically considers some methodological novelties in cancer research, motivated by various features of tumours as complex diseases, and shows how they encourage some rethinking of philosophical discourses on those topics. In particular, we discuss the integrative-cluster approach, and analyse its potential in the epistemology of cancer. We suggest that, far from being the solution to tame cancer (...) complexity, this approach offers a philosophically interesting new manner of considering integration, and show how it can help addressing the apparent contrast between a pluralistic and a unitary account. (shrink)

Not only has the philosophical debate on causation been gaining ground in the last few decades, but it has also increasingly addressed the sciences. The biomedical sciences are among the most prominent fields that have been considered, with a number of works tackling the understanding of the notion of cause, the assessment of genuinely causal relations and the use of causal knowledge in applied contexts. Far from denying the merits of the debate on causation and the major theories it comprises, (...) this paper is meant as a stimulus for theorists of causation in the philosophy of biomedicine, with a focus on clinical matters. Without aiming at putting forward an original theory of causation and starting from the narration of two actual but paradigmatic cases at the joints between biomedical research and clinical practice, we want to point out that some pathological situations addressed by molecular medicine actually prove resistant to some of our major epistemological accounts of causal explanation. Given this scenario, which is very frequent in our hospitals, our analysis aims to provide a stimulus for the debate among theorists of causation in biomedicine interested in real cases in science in practice. We believe that this might in turn encourage some more general rethinking of the complex intertwinement of science, philosophy of science and ethics, as well as of the role of philosophy of science for clinical medicine itself. (shrink)

Complexity and integration are longstanding widely debated issues in philosophy of science and recent contributions have largely focused on biology and biomedicine. This paper specifically considers some methodological novelties in cancer research, motivated by various features of tumours as complex diseases, and shows how they encourage some rethinking of philosophical discourses on those topics. In particular, we discuss the integrative-cluster approach, and analyse its potential in the epistemology of cancer. We suggest that, far from being the solution to tame cancer (...) complexity, this approach offers a philosophically interesting new manner of considering integration, and show how it can help addressing the apparent contrast between a pluralistic and a unitary account. (shrink)

Complexity and integration are longstanding widely debated issues in philosophy of science and recent contributions have largely focused on biology and biomedicine. This paper specifically considers some methodological novelties in cancer research, motivated by various features of tumours as complex diseases, and shows how they encourage some rethinking of philosophical discourses on those topics. In particular, we discuss the integrative-cluster approach, and analyse its potential in the epistemology of cancer. We suggest that, far from being the solution to tame cancer (...) complexity, this approach offers a philosophically interesting new manner of considering integration, and show how it can help addressing the apparent contrast between a pluralistic and a unitary account. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check (...) which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

This work addresses biological explanations and aims to provide a philosophical account which brings together logical-procedural and historical-processual aspects when considering molecular pathways. It is argued that, having molecular features as explananda, a particular non-classical logical language – Zsyntax – can be used to formally represent, in terms of logical theorems, types of molecular processes, and to grasp how we get from one molecular interaction to another, hence explaining why a given outcome occurs. Expressing types of molecular biology processes in (...) terms of the Zsyntax language allows us to represent causal interactions by taking into account their context-sensitivity, and amounts to partly reviving the spirit of the so-called received view of explanation – which aimed to capture scientific explanatory accounts in terms of their logical structure and their appealing to nomological relations. Such a partial revival is pursued by invoking here non-classical deductions and empirical generalisations, which are called to provide the epistemic norms to explain the behavior of molecular pathways. (shrink)

The present volume is one of a type we should soon expect to be seeing more of in philosophy of medicine. Philosophy of medicine has now been around long enough that entire careers, or at least substantial portions of careers, can and have been devoted to it. This is an important milestone in the field.This is true, even though, as the author indicates in the introduction, this is not solely a book of philosophy of medicine. Investigations in philosophy of medicine, (...) and the essays included in this volume in particular, can not only contribute to “the development of philosophy of medicine as a discipline” but can also “test and help revise some of [philosophy of science’s] views” . Thus, this book is intended as a contribution both to philosophy of medicine as a specific discipline and to philosophy of science generally. Both of these aspects of the book could attract the attention of the current audience.The book focuses .. (shrink)

This book examines the role of note-taking in ancient education as a pedagogical method, by taking readers on a stimulating analysis of lectures by ancient philosophers that were recorded by their students.

ABSTRACTThe quality of medicines is generally adequately assured by manufacturers and regulatory authorities for well-resourced settings, while the implementation of existing quality standards is challenged in many low- and middle-income countries. This situation of multiple pharmaceutical standards raises the question whether it could ever be ethically justified to compromise on the quality assurance of medicines depending on what individuals, communities, or societies can afford. In this paper, we contend that ethically, any unjustified exceptions to medicines’ quality assurance represents a violation (...) of the principles of beneficence and non-maleficence. Exceptions are only acceptable in exceptional and temporary circumstances, if based on a meaningful quality risk assessment, guided by a rigorous ethical framework built on the principles of independence, technical competence, transparency, and accountability. We also discuss how such exceptional and temporary circumstances should be defined/justified.... (shrink)

Alison Simmons, in Simmons (1999), argues that Descartes in Meditation Six offered a teleological account of sensory representation. According to Simmons, Descartes’ view is that the biological function of sensations explains both why sensations represent what they do (i.e., their referential content) and why they represent their objects the way they do (i.e., their presentational content). Moreover, Simmons claims that her account has several advantages over other currently available interpretations of Cartesian sensations. In this paper, I argue that Simmons’ teleological (...) account cannot be sustained for both theoretical and textual reasons and that it does not have the advantages it is claimed to have. (shrink)

The essay analyses utopia as a key concept to investigate modern politics. It argues that looking at the works of Machiavelli and More in order to retrace the utopia-realism nexus permits to develop a valuable analytical tool to interpret the outset of political modernity.