In this paper I argue that ethics and evidence are intricately intertwined within the clinical practice of differential diagnosis. Too often, when a disease is difficult to diagnose, a physician will dismiss it as being “not real” or “all in the patient’s head.” This is both an ethical and an evidential problem. In the paper my aim is two-fold. First, via the examination of two case studies (late-stage Lyme disease and Addison’s disease), I try to elucidate why this kind (...) of dismissal takes place. Then, I propose a potential solution to the problem. I argue that instead of dismissing a patient’s illness as “not real,” physicians ought to exercise a compassionate suspension of judgment when a diagnosis cannot be immediately made. I argue that suspending judgment has methodological, epistemic, and ethical virtues and therefore should always be preferred to patient dismissal in the clinical setting. (shrink)

This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography. A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produced by the subarachnoid hemorrhage. She exhibited impaired consciousness with a Coma Recovery Scale-Revised score of 13 until 1 month after onset. Her impaired consciousness recovered slowly to a normal state according to the Coma Recovery Scale-Revised at 7 weeks after onset. (...) On the other hand, she exhibited the typical clinical features of akinetic mutism. On the DTT performed at 1-month, the upper, and lower dorsal ascending reticular activating systems, which are related to a disorder of consciousness, showed an almost normal state. In contrast, the prefronto-caudate and prefronto-thalamic tracts, which are related to akinetic mutism, showed severe injuries. These DTT results suggested that the patient's main clinical features were not a disorder of consciousness but akinetic mutism. Therefore, DTT for the ascending reticular activating system, and the prefronto-caudate and prefronto-thalamic tracts could provide additional evidence for a differential diagnosis of DOC and AM at the early stages of stroke. (shrink)

In considering the argument that Thomas Szasz advances on behalf of his claim that there is no mental illness, it becomes evident that despite his stated assumptions, moral valuations are necessarily tied up with assessment of disease. By following his remarks about differential diagnosis, it becomes evident that behavior is the occasion for differential diagnosis, that behavior determines which anatomical deviations are counted as diseases, and that Szasz's insistence on autonomy introduces his own moral assumptions into the concept (...) of disease. Consequently, although none of these considerations disproves Szasz's conclusions about the existence of mental illness, neither can his argument support the weight of that conclusion. CiteULike Connotea Del.icio.us What's this? (shrink)

Communication problems are often the first noticeable symptom of developmental abnormalities. About 15% of children at the age of 2 years demonstrate a lower level of speech expression than their peers. Speech development disorders may constitute either symptoms of global developmental delay or only isolated difficulties. One of the main challenges for professionals dealing with early development support is recognizing whether a child whose linguistic competence differs significantly from that of their peers suffers from a specific language impairment, or whether (...) they belong to the group of ‘late bloomers’ who at some point, without the intervention of a specialist, will achieve an appropriate level of communication skills. Although a differential diagnosis can be extremely difficult, the analysis of the literature leads to the conclusion that there are some markers that can aid a specialist in establishing an accurate diagnosis. (shrink)

I suggest that the diagnosis that an individual self-diagnoses with can be influenced by levels of public awareness. Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known. I then outline a potential (...) negative consequence of this. Psychiatric diagnoses can grant access to what I call social resources, namely, political advocacy, campaigning for support, participating in scientific research, building diagnostic cultures, and opportunity for social interactions with people who have the same diagnosis. The strength of the social resources for a particular diagnosis can be made stronger when more people have that diagnosis. As such, inaccurate self-diagnosis can result in the social resources for one diagnosis being strengthened whilst not being strengthened in relation to another diagnosis in comparison to accurate diagnosis. This shows how inaccurate self-diagnosis can alter the distribution of social resources. We need to consider whether this is unfair to people who are diagnosed with less well-known conditions. (shrink)

Background and purposeWe previously established a radiological protocol to discriminate multiple system atrophy-parkinsonian subtype from Parkinson’s disease. However, we do not know if it can differentiate early stage disease. This study aimed to investigate whether the morphological and intensity changes in susceptibility weighted imaging of the lentiform nucleus could discriminate MSA-P from PD at early stages.MethodsWe retrospectively enrolled patients with MSA-P, PD and sex- and age-matched controls whose brain MRI included SWI, between January 2015 and July 2020 at the Movement (...) Disorder Center. Two specialists at the center reviewed the medical records and made the final diagnosis, and two experienced neuroradiologists performed MRI analysis, based on a defined and revised protocol for conducting morphological measurements of the LN and signal intensity.ResultsNineteen patients with MSA-P and 19 patients with PD, with less than 2 years of disease duration, and 19 control individuals were enrolled in this study. We found that patients with MSA- P presented significantly decreased size in the short line and corrected short line, ratio of the SL to the long line and corrected SLLr of the LN, increased standard deviation of signal intensity compared to patients with PD and controls. With receiver operating characteristic analysis, this finding had a sensitivity of 89.5% and a specificity of 73.7% to distinguish MSA- P from PD.ConclusionCompared to PD and controls, patients with MSA-P are characterized by a narrowing morphology of the posterior region of the LN. Quantitative morphological changes provide a reference for clinical auxiliary diagnosis. (shrink)

In the big data era, sequencing technology has produced a large number of biological sequencing data. Different views of the cancer genome data provide sufficient complementary information to explore genetic activity. The identification of differentially expressed genes from multiview cancer gene data is of great importance in cancer diagnosis and treatment. In this paper, we propose a novel method for identifying differentially expressed genes based on tensor robust principal component analysis, which extends the matrix method to the processing of multiway (...) data. To identify differentially expressed genes, the plan is carried out as follows. First, multiview data containing cancer gene expression data from different sources are prepared. Second, the original tensor is decomposed into a sum of a low-rank tensor and a sparse tensor using TRPCA. Third, the differentially expressed genes are considered to be sparse perturbed signals and then identified based on the sparse tensor. Fourth, the differentially expressed genes are evaluated using Gene Ontology and Gene Cards tools. The validity of the TRPCA method was tested using two sets of multiview data. The experimental results showed that our method is superior to the representative methods in efficiency and accuracy aspects. (shrink)

RESUMEN Se desarrolló una investigación descriptiva transversal, con un enfoque cuantitativo, en la que la muestra fue seleccionada de manera intencional pura, no probabilística, según criterios establecidos por los autores del estudio. Quedó constituida por las variables del Sistema Comprehensivo Rorschach pertenecientes a 120 protocolos de sujetos con trastornos depresivos, de ellos 82 presentaron depresión moderada, y 38 depresión severa. Se aplicaron los siguientes métodos empíricos: entrevista, observación, Autoescala de Zung y Conde, y el Psicodiagnóstico de Rorschach. Los estadígrafos que (...) se utilizaron fueron el Test de Kolmogorov- Smirnov, el Test de Comparación de Proporciones y la prueba de Mann-Whitney. Como principales resultados se obtuvo que las variables del Sistema Comprehensivo Rorschach, que establecieron diferencias estadísticas altamente significativas entre los grupos de sujetos fueron: Lambda alta, Proporción afectiva baja, total de respuestas, las respuestas globales, Suma Ponderada de respuestas con el determinante color cromático y la Experiencia accesible. ABSTRACT A transverse descriptive investigation was developed, with a quantitative approach, in that the sample was selected in a pure intentional way, not probabilistic, according to criteria established by the authors of the study. It was constituted for the variables of the Rorschach Comprehensive System belonging to 120 protocols of individuals with depressive disorders, of them 82 presented moderate depression, and 38 severe depression. The following empirical methods were applied: interview, observation, Auto-scale of Zung and Conde, and Psycho-diagnosis of Rorschach. The statisticians used were the Test of Kolmogorov - Smirnov, the Test of Comparison of Proportions and the Mann-Whitney test. As main results, it was obtained that the variables of the Rorschach Comprehensive System, which established highly significant statistical differences between the groups of individuals were: tall Lambda, low affective proportion, whole of answers, the global answers, exaggerated sum of answers with the determinant chromatic color and the accessible experience. (shrink)

The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of moral responsibility. Understanding (...) the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND. (shrink)

This paper articulates a dilemma posed by philosophical counseling literature that presupposes diagnostic recognition. In addition, guests often bring self-ascribed mental health diagnoses from their previous experience, and requests the philosophical counselor to de-diagnose or otherwise reinterpret their problems. Although philosophical counselors can do this, we cannot skirt philosophical diagnosis. The paper’s thesis is that it behooves philosophical counselors to differentiate these types of diagnosis and to know when we are doing one or the other, including the utilization of diagnostic (...) recognition. Anecdotes from the author’s philosophical counseling sessions are included to illustrate the discussion. The paper concludes that the space of philosophical diagnosis is neither incommensurate with, nor incompatible with clinical diagnosis. On the contrary, the space of philosophical diagnosis ought to harbor the possibility of clinical diagnostic recognition. The philosophical counselor’s repertoire of diagnostic intuitions should cultivate the intuitive recognition of clinical prototypes. (shrink)

IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according (...) to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

Medical diagnosis has been traditionally recognized as a privileged field of application for so called probabilistic induction. Consequently, the Bayesian theorem, which mathematically formalizes this form of inference, has been seen as the most adequate tool for quantifying the uncertainty surrounding the diagnosis by providing probabilities of different diagnostic hypotheses, given symptomatic or laboratory data. On the other side, it has also been remarked that differential diagnosis rather works by exclusion, e.g. by modus tollens, i.e. deductively. By drawing on (...) a case history, this paper aims at clarifying some points on the issue. Namely: 1) Medical diagnosis does not represent, strictly speaking, a form of induction, but a type, of what in Peircean terms should be called ‘abduction’ (identifying a case as the token of a specific type); 2) in performing the single diagnostic steps, however, different inferential methods are used for both inductive and deductive nature: modus tollens, hypothetical-deductive method, abduction; 3) Bayes’ theorem is a probabilized form of abduction which uses mathematics in order to justify the degree of confidence which can be entertained on a hypothesis given the available evidence; 4) although theoretically irreconcilable, in practice, both the hypothetical- deductive method and the Bayesian one, are used in the same diagnosis with no serious compromise for its correctness; 5) Medical diagnosis, especially differential diagnosis, also uses a kind of “probabilistic modus tollens”, in that, signs (symptoms or laboratory data) are taken as strong evidence for a given hypothesis not to be true: the focus is not on hypothesis confirmation, but instead on its refutation [Pr (¬ H/E1, E2, …, En)]. Especially at the beginning of a complicated case, odds are between the hypothesis that is potentially being excluded and a vague “other”. This procedure has the advantage of providing a clue of what evidence to look for and to eventually reduce the set of candidate hypotheses if conclusive negative evidence is found. 6) Bayes’ theorem in the hypothesis-confirmation form can more faithfully, although idealistically, represent the medical diagnosis when the diagnostic itinerary has come to a reduced set of plausible hypotheses after a process of progressive elimination of candidate hypotheses; 7) Bayes’ theorem is however indispensable in the case of litigation in order to assess doctor’s responsibility for medical error by taking into account the weight of the evidence at his disposal. (shrink)

This paper examines the philosophical substructure to the theoretical conflicts that permeate contemporary mental health care in the UK. Theoretical conflicts are treated here as those that arise among practitioners holding divergent theoretical orientations towards the phenomena being treated. Such conflicts, although steeped in history, have become revitalized by recent attempts at integrating mental health services that have forced diversely trained practitioners to work collaboratively together, often under one roof. Part I of this paper examines how the history of these (...) conflicts can be understood as a tension between, on the one hand, the medical model and its use by the dominant profession of psychiatry, and on the other, those alternative models and practitioners in some way differentiated from the medical model camp. Examples will be given from recent policy and research to highlight the prevalence of this tension in contemporary practice. Part II of this paper explores the deeper commonalities that lay beneath the theoretical conflict outlined in Part I. These commonalities will be shown to be apart of a captivating framework that has continued to grip the conflict since its inception. By exposing this underlying framework--and the motivations inherent therein--the topic of integration appears in wholly different light, allowing a renewed philosophical basis for integration to emerge. (shrink)

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. (...) Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are nonverified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it "cancer screening" when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis. (shrink)

We argue that the causal theory of memory and the simulation theory of memory are not as straightforwardly incompatible as they are usually taken to be. Following a brief review of the theories, we describe alternative normative and descriptive perspectives on memory, arguing that the causal theory aligns better with the normative perspective and the simulation theory with the descriptive perspective. Taking explanatory contextualism about perception as our starting point, we then develop a form of explanatory contextualism about memory, arguing (...) that, depending on the context in which we find ourselves, either the normative perspective or the descriptive perspective may be appropriate. It follows that, while the causal theory and the simulation theory cannot both be right with respect to a given perspective, and while it is necessary to choose one perspective or the other in a given context, there an important sense in which we need not choose between causalism and simulationism. We conclude by differentiating our position from and critiquing a related position developed by Craver (2020) and defending our position against objections. (shrink)

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. (...) Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis. (shrink)

In Germany the question whether to uphold or repeal the judicial prohibition on Pre-implantation Genetic Diagnosis is being debated from quite different standpoints. This paper differentiates the major arguments according to their reasons as a) moral, b) evaluative , and c) legal. The arguments for and against PGD can be divided by content into three groups: arguments relating to the status of the embryo, focusing on individual actions in the implementation of PGD, and relating to the foreseeable or probable consequences (...) of PGD.In Germany, from a legal perspective, the status of the embryo does not permit the intervention of PGD; from a purely moral perspective, a prohibition on PGD does not appear defensible. It remains an open question, however, whether the moral argument permitting PGD should be restricted for evaluative reasons. The paper discusses the species-ethical reasons, for which Jürgen Habermas sees worrisome consequences in the wake of PGD to the extent that we comprehend it as the forerunner of a ‘positive eugenics’. It would so disrupt the natural preconditions of our universal morality. The question of whether to prohibit or allow PGD is not merely a question of simple moral and/or legal arguments, but demands a choice between evaluative, moral and species-ethical arguments, and the question remains open. (shrink)

There are indications that the interpersonal affective factor and the social deviation factor, both of which are underlying dimensions of psychopathy, have a positive and a negative relationship, respectively, with executive functioning. However, this is seldom taken into consideration in the research on the relationship between executive functioning and psychopathy, which may be an explanation for the many inconsistent results in this area as reported in the literature (e.g., Rogers, 2006). In the present study, executive functioning was studied using the (...) Wisconsin Card Sorting Test (WCST) in 53 inpatients of a Dutch forensic psychiatric clinic who were classified by means of the Psychopathy Checklist-Revised (PCL-R). Special attention was given to the relationship between the two separate factors and executive functioning. Age, educational level, and substance abuse were controlled for in the analysis. No difference was found between psychopathic (N = 17) and nonpsychopathic (N = 36) patients in the WCST scoring categories, nor was there a significant difference in the four diagnostic subgroups defined by the two factors. However, the trends observed do justify further study in this direction. (shrink)

Professor Jennett first defines the term `brain death' and the problems arising from a diagnosis of death, some the result of recent technological advances. The diagnosis is not necessarily connected with donor transplants, although in the popular mind this is still so. The criteria for establishing brain death and the sources of potential error in this diagnosis are outlined. The diagnosis of brain death can be made confidently, as is already common practice, and this should become standard good medical practice.

Psychiatry has long struggled with the nature of its diagnoses. This book brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology. The contributors include philosophers, psychologists, psychiatrists, historians and representatives of the efforts of DSM-III, DSM-IV and DSM-V.

Differential diagnosis of motor symptoms, for example, akinesia, may be difficult in clinical neuropsychiatry. Symptoms may be either of neurologic origin, for example, Parkinson's disease, or of psychiatric origin, for example, catatonia, leading to a so-called “conflict of paradigms.” Despite their different origins, symptoms may appear more or less clinically similar. Possibility of dissociation between origin and clinical appearance may reflect functional brain organisation in general, and cortical-cortical/subcortical relations in particular. It is therefore hypothesized that similarities and differences between (...) Parkinson's disease and catatonia may be accounted for by distinct kinds of modulation between cortico-cortical and cortico-subcortical relations. Catatonia can be characterized by concurrent motor, emotional, and behavioural symptoms. The different symptoms may be accounted for by dysfunction in orbitofrontal-prefrontal/parietal cortical connectivity reflecting “horizontal modulation” of cortico-cortical relation. Furthermore, alteration in “top-down modulation” reflecting “vertical modulation” of caudate and other basal ganglia by GABA-ergic mediated orbitofrontal cortical deficits may account for motor symptoms in catatonia. Parkinson's disease, in contrast, can be characterized by predominant motor symptoms. Motor symptoms may be accounted for by altered “bottom-up modulation” between dopaminergic mediated deficits in striatum and premotor/motor cortex. Clinical similarities between Parkinson's disease and catatonia with respect to akinesia may be related with involvement of the basal ganglia in both disorders. Clinical differences with respect to emotional and behavioural symptoms may be related with involvement of different cortical areas, that is, orbitofrontal/parietal and premotor/motor cortex implying distinct kinds of modulation – “vertical” and “horizontal” modulation, respectively. Key Words: Bottom-up modulation; catatonia; horizontal modulation; Parkinson's disease; top-down modulation; vertical modulation. (shrink)

The transformational pace of modern education, healthcare, business management systems, etc., requires new approaches for prompt and reliable personality assessment. Phenotypology is one of such theories and it claims of the discovered interconnections of a person’s psychological and psychophysical characteristics on the basis of individual features of his/her phenotype. The article aim is to present some validation results for the Phenotypology hypotheses as a possible tool for personality assessment. In order to verify connections between phenotypic treats and individual behavior, we (...) conducted the study when respondents were differentiated according to some anthropometric (facial) peculiarities and characterological features. The results were quantified and analyzed using the mathematical-statistical linear regression. The research output contains the rationale for the conclusion that there are no statistically significant correlations between some phenotypic body features and such individual psychological characteristics as aggressiveness, impetuosity, pedantry, passivity, etc. In particular, the validity of using of appropriate phenotypologic representations to predict the examined character traits was studied. The obtained results disproved the possibility to use directly the phenotypic approach for reliable characterological profiling. Though, the study outcome is tentative due to some limitations on generality. It is necessary to continue verification of the Phenotypology hypotheses with a broader experimental sample with the inclusion of various ethnic and racial groups’ representatives. However, until then, based on actual findings, the practical application of the Phenotypology statements is doubtful, at least for the purposes of character diagnosis and personality assessment. (shrink)

When confronting the issues related to developments in modern medicine and biotechnology, we must repeatedly ask ourselves anew what can and cannot be justified in an ethical sense. For radically new ethical questions seem to arise through innovative techniques such as stem cell research or preimplantation diagnosis — and with them new areas of conflicting interests. If one scrutinizes the previous positions related to this subject, it becomes conspicuous that a multitude of questions has quickly piled up — however, (as (...) in the case of Germany) comprehensive and differentiated views have mostly been lacking. (shrink)

The article offers a critical assessment of an article on “Corporate Legitimacy as Deliberation” by Guido Palazzo and Andreas Scherer in this journal. We share the concern about the precarious legitimacy of globally active corporations, infringing on the legitimacy of democracy at large. There is no quarrel with Palazzo/Scherer’s diagnosis, which focuses on the consequences of globalization and ensuing challenges for corporate social responsibilities. However, we disagree with the “solutions” offered by them. In a first step we refute the idea (...) of a legitimacy of morals, maintaining that morality is a premodern mode of creating legitimacy. Even worse, moral is becoming a dangerous commodity under conditions of fundamental global disagreements and antagonisms. We secondly refute the concept of the “politicized corporation”, maintaining that Palazzo/Scherer disregard the consequences of functional differentiation of modern societies and, in particular, disregard the wisdom of political restraint and constitutional guarantees for the autonomy of different spheres of society. Finally, we refute a seemingly romantic notion of deliberation, maintaining that deliberation and deliberative democracy is a worthy idea, which, however, has no place in the real world of globalized contexts. On the other hand, we also find enough common ground and common concern with Palazzo/Scherer to validate a fruitful discourse. (shrink)

The ability to differentiate between what is just and what is unjust may be considered as the precondition to demand one's own rights. Starting from this point, this research was carried out to describe the level of awareness of patients concerning their rights. The main hypothesis was: the higher the socioeconomic and cultural level of patients, the higher is their awareness of their rights. This research was conducted in one of the state hospitals in Turkey in 1998. It is a (...) descriptive study carried out on 128 inpatients in medical and surgical wards. The data were collected by a questionnaire, which included questions on the rights of patients and gave sample cases. The sample cases were designed by referring to the World Health Organization Declaration on the Promotion of Patients' Rights in Europe. Only 23% of the participants were able to recognize patient rights, while 32% could not; the majority (45%) were undecided in recognizing patient rights. The awareness scores were statistically significantly different for educational level categories (F = 5.84; p<0.001). A continuously declining trend was observed for patient rights awareness scores from the highest educational level to the lowest. This partly proves the hypothesis of the research. However, the awareness scores were not significantly different for the other background variables (p>0.05). Most strikingly, 38% of the patients had no idea about their diagnosis and 63% of those who had undergone surgery did not know why they had had the operation. (shrink)

The chapter is divided into three separate parts. In the first part I critically discuss Adorno's interpretation of Heidegger's concern with the question of Being. Central to this interpretation is Adorno's view that Being, for Heidegger, resonates with onto‐theological or metaphysical accounts of the highest and most general being – that of Plato's ideas, or Aristotle's substance. In various steps, looking at several key claims of Heidegger, I argue that this approach is misguided. Heidegger draws a clear and philosophically justified (...) distinction between his conception of Being and the Platonic vision of essence. The second part identifies a strand of Adorno's critique that does not depend on the onto‐theological reading. This is the critique of fetishization and reification – Adorno's view that Heidegger falsely seeks to imbue his thinking and diagnosis of modernity with a veneer of the timeless and transcendental. Adorno, I suggest, justifiably introduces his dialectical procedure as a means to correct this tendency: Concepts, he claims, should be viewed and analyzed in terms of the non‐identity between themselves and the states of affairs to which they purport to refer. In clear contrast to the Heideggerian call for some kind of essential or necessary reference – words that magically yet “necessarily” pick out their object, and that thereby aspire to overcome the fateful split between word and object (or subject and object) – Adorno insists on difference, differentiation, and absence, a historically indexed self‐reflection. In the final part I propose a reading of Heidegger that takes heed of Adorno's warnings against fetishization and reification. While far from trying to efface the decisive differences between the two thinkers, I highlight moments in Heidegger that lend themselves to a dialectical interpretation. I argue that these are moments of remembrance – moments in which human practice anticipate a more reconciled relation between subject and object. (shrink)

Richard Koch first made his appearance in the 1920s with works published on the foundations of medicine. These publications describe the character of medicine as an action and the status of medicine within the theory of science. One of his conclusions is that medicine is not a science in the original sense of the word, but a practical discipline. It serves a practical purpose: to heal the sick. All medical knowledge is oriented towards this purpose, which also defines the physician’s (...) role. One kind of knowledge is diagnosis, which is strictly understood in relation to therapy, and is at the core of medical thinking. Diagnosis is not the assignment of a term of a species to a patient’s disease: this would not do justice to the individuality of a clinical manifestation and would fail to provide a reason for individual therapy. Nevertheless, the terms assigned to diseases, although fictitious, are not useless, but assist in differentiating various phenomena. These conclusions carry ethical consequences. Because the task of helping the sick constitutes medicine, morals not only set ethical limits: medicine originates in a moral decision. If there are no diseases but only individual sick people, disease can not be defined as an abnormality. The individual benefit to the patient must not necessarily be the complete restoration of health. With its object being incalculable, medicine cannot guarantee its own success. Here the physician has to develop principles that allow for the best possible response to the challenges faced in varying situations of conduct. (shrink)

Colin Crouch and Jacques Ranciere have coined the concept of post-democracy to articulate the suspicion that aspirations and reality of today's democracies fall apart. Western societies still regard themselves as democratic; they follow democratic constitutions and adhere to democratic procedures, but in fact they are no longer governed by the people but by economic elites. The contributions to this volume will discuss this diagnosis: How viable is it and what are its limits? Is it just a new pessimistic or even (...) apocalyptic discourse or a diagnosis which could be further differentiated? How can we relate the diagnosis to everyday life and to micropolitics? Similarly, if the diagnosis works: With which forms of social exclusion post-democracy will go along? What is its relation to bio-politics? What impact will post-democracy have on subjects and their affects? How does post-democracy correspond to new politics of resentment and right-wing populism? (shrink)

Precise and timely diagnosis of Parkinson’s disease is important to control its progression among subjects. Currently, a neuroimaging technique called dopaminergic imaging that uses single photon emission computed tomography (SPECT) with 123I-Ioflupane is popular among clinicians for detecting Parkinson’s disease in early stages. Unlike other studies, which consider only low-level features like gray matter, white matter, or cerebrospinal fluid, this study explores the non-linear relation between different biomarkers (SPECT + biological) using deep learning and multivariate logistic regression. Striatal binding ratios (...) are obtained using 123I-Ioflupane SPECT scans from four brain regions which are further integrated with five biological biomarkers to increase the diagnostic accuracy. Experimental results indicate that this investigated approach can differentiate subjects with 100% accuracy. The obtained results outperform the ones reported in the literature. Furthermore, logistic regression model has been developed for estimating the Parkinson’s disease onset probability. Such models may aid clinicians in diagnosing this disease. (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

Faith in the universal moral equality of people enjoys close to unanimous consensus in present moral and political philosophy. Yet its philosophical justification remains precarious. The search for the basis of equality encounters insurmountable difficulties. Nothing short of a miracle seems required to stabilize universal equality in moral status amidst a vast space of distinctions sprawling between people. The difficulties of stabilizing equality against differentiation are not specific to any particular choice regarding the basis of equality. To show this, I (...) will provide a general diagnosis of the difficulty together with its application to the arguably best attempt at a solution, namely to ground moral equality in a form of subjectivity. In his recent book Equality for Nonegalitarians, George Sher advances the view that “we are moral equals because we are equally centers of consciousness. …The fact that we are equals in this respect—that each is a world unto himself—…explains why each person’s interests are of equal moral importance”. Yet the worlds we are unto ourselves can no more withstand the force of differentiation than previous candidates suggested in the literature, and the reasons why run deeper than even some critics have recognized. The prospects for vindicating universal moral equality remain bleak. (shrink)

Faith in the universal moral equality of people enjoys close to unanimous consensus in present moral and political philosophy. Yet its philosophical justification remains precarious. The search for the basis of equality encounters insurmountable difficulties. Nothing short of a miracle seems required to stabilize universal equality in moral status amidst a vast space of distinctions sprawling between people. The difficulties of stabilizing equality against differentiation are not specific to any particular choice regarding the basis of equality. To show this, I (...) will provide a general diagnosis of the difficulty together with its application to the arguably best attempt at a solution, namely to ground moral equality in a form of subjectivity. In his recent book Equality for Nonegalitarians, George Sher advances the view that “we are moral equals because we are equally centers of consciousness. …The fact that we are equals in this respect—that each is a world unto himself—…explains why each person’s interests are of equal moral importance”. Yet the worlds we are unto ourselves can no more withstand the force of differentiation than previous candidates suggested in the literature, and the reasons why run deeper than even some critics have recognized. The prospects for vindicating universal moral equality remain bleak. (shrink)

According to Axel Honneth, Adorno's very idea of social critique is self‐defeating. It tries to account for what is wrong, deformed, or pathological without providing any positive yardstick. Honneth's idea of critique is a diagnosis of chronic dysfunctions in the relations of recognition upon which the society in question is grounded. Under such conditions of misrecognition, institutions that embody what he calls social freedom regress to negative freedom. However, such a deficit‐based notion of critique does not square with Honneth's own (...) diagnosis of our present: namely, the transformation from welfare capitalism to neoliberalism. In fact, Honneth's diagnosis is very much in line with Adorno's idea of late capitalism as a society of “total integration.” Adorno's matching conception of critique, it is argued, avoids the problems Honneth runs into. At the basis of Adorno's critical idiom are two key points: an explanation of how social relations can be functional while contradictory and an account of social domination that is diffused throughout society while being differentially experienced by different classes. Adorno's answer to Honneth's concern, regarding the lack of a positive yardstick, is that it is domination that gives meaning to our idea of freedom, rather than the other way around. (shrink)

Age‐related and cancer‐related epigenomic modifications have been associated with enhanced cell‐to‐cell gene expression variability that characterizes increased cellular stochasticity. Since gene expression variability appears to be highly reduced by—and epigenetic and phenotypic stability acquired through—direct or long‐range cellular interactions during cell differentiation, we propose a common origin for aging and cancer in the failure to control cellular stochasticity by cell–cell interactions. Tissue‐disruption‐induced cellular stochasticity associated with epigenetic drift would be at the origin of organ dysfunction because of an increase in (...) phenotypic variation among cells, ultimately leading to cell death and organ failure through a loss of coordination in cellular functions, and eventually to cancerization. We propose mechanistic research perspectives to corroborate this hypothesis and explore its evolutionary consequences, highlighting a positive correlation between the median age of mass loss onset (a proxy for the onset of organ aging) and the median age at cancer diagnosis. (shrink)

The initial successes in recent years in harnessing machine learning technologies to improve medical practice and benefit patients have attracted attention in a wide range of healthcare fields. Particularly, it should be achieved by providing automated decision recommendations to the treating clinician. Some hopes placed in such ML-based systems for healthcare, however, seem to be unwarranted, at least partially because of their inherent lack of transparency, although their results seem convincing in accuracy and reliability. Skepticism arises when the physician as (...) the agent responsible for the implementation of diagnosis, therapy, and care is unable to access the generation of findings and recommendations. There is widespread agreement that, generally, a complete traceability is preferable to opaque recommendations; however, there are differences about addressing ML-based systems whose functioning seems to remain opaque to some degree—even if so-called explicable or interpretable systems gain increasing amounts of interest. This essay approaches the epistemic foundations of ML-generated information specifically and medical knowledge generally to advocate differentiations of decision-making situations in clinical contexts regarding their necessary depth of insight into the process of information generation. Empirically accurate or reliable outcomes are sufficient for some decision situations in healthcare, whereas other clinical decisions require extensive insight into ML-generated outcomes because of their inherently normative implications. (shrink)

Developments in Machine Learning (ML) have attracted attention in a wide range of healthcare fields to improve medical practice and the benefit of patients. Particularly, this should be achieved by providing more or less automated decision recommendations to the treating physician. However, some hopes placed in ML for healthcare seem to be disappointed, at least in part, by a lack of transparency or traceability. Skepticism exists primarily in the fact that the physician, as the person responsible for diagnosis, therapy, and (...) care, has no or insufficient insight into how such recommendations are reached. The following paper aims to make understandable the specificity of the deliberative model of a physician-patient relationship that has been achieved over decades. By outlining the (social-)epistemic and inherently normative relationship between physicians and patients, I want to show how this relationship might be altered by non-traceable ML recommendations. With respect to some healthcare decisions, such changes in deliberative practice may create normatively far-reaching challenges. Therefore, in the future, a differentiation of decision-making situations in healthcare with respect to the necessary depth of insight into the process of outcome generation seems essential. (shrink)

The article offers a critical assessment of an article on "Corporate Legitimacy as Deliberation" by Guido Palazzo and Andreas Scherer in this journal. We share the concern about the precarious legitimacy of globally active corporations, infringing on the legitimacy of democracy at large. There is no quarrel with Palazzo/Scherer's diagnosis, which focuses on the consequences of globalization and ensuing challenges for corporate social responsibilities. However, we disagree with the "solutions" offered by them. In a first step we refute the idea (...) of a legitimacy of morals, maintaining that morality is a premodern mode of creating legitimacy. Even worse, moral is becoming a dangerous commodity under conditions of fundamental global disagreements and antagonisms. We secondly refute the concept of the "politicized corporation", maintaining that Palazzo/Scherer disregard the consequences of functional differentiation of modern societies and, in particular, disregard the wisdom of political restraint and constitutional guarantees for the autonomy of different spheres of society. Finally, we refute a seemingly romantic notion of deliberation, maintaining that deliberation and deliberative democracy is a worthy idea, which, however, has no place in the real world of globalized contexts. On the other hand, we also find enough common ground and common concern with Palazzo/Scherer to validate a fruitful discourse. (shrink)

This paper evaluates the argument for the contradictoriness of unity, that be- gins Priest’s recent book One. The argument is seen to fail because it does not adequately differentiate between different forms of unity. This diagnosis of the argument’s failure is used as a basis for two consistent accounts of unity. The paper concludes by arguing that reality contains two absolutely fundamental and unanalysable forms of unity, which are in principle presupposed by any theory of anything. These fundamental forms of (...) unity are closely related to the unity of propositions and facts. (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

In this paper, we introduce a distinctive kind of psychological abuse we call Tightlacing. We begin by presenting four examples and argue that there is a distinctive form of abuse in these examples that cannot be captured by our existing moral categories. We then outline our diagnosis of this distinctive form of abuse. Tightlacing consists in inducing a mistaken self-conception in others that licenses overburdening demands on them such that victims apply those demands to themselves. We discuss typical Tightlacing strategies (...) and argue that Tightlacing typically is manipulative. Typical tightlacers will be motivated by a strong desire to suppress a kind of behaviour on the victim’s part. We will then differentiate Tightlacing from a related and widely discussed form of psychological abuse, Gaslighting. While Gaslighting focuses on the victim’s epistemic capacities and typically serves to insulate the abuser from potential dissent, Tightlacing focuses on the kind of person the victim is and typically serves to insulate the abuser from confronting ways of behaviour they cannot cope with. While Gaslighting targets the victim’s epistemic self-trust, Tightlacing targets their basic sense of who they are and their sense of entitlement to conduct themselves as who they really are. We finish by diagnosing the wrong-making features of Tightlacing, arguing that Tightlacing, among many secondary wrongs, makes the victim complicit in a denial of their rights as well as an erasure of who they are. (shrink)

Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to (...) offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers. (shrink)

The calcium signals regulate the production and secretion of many signaling molecules like inositol trisphosphate ( $$IP_{3}$$ ) and adenosine triphosphate (ATP) in various cells including pancreatic $$\beta$$ -cells. The calcium signaling mechanisms regulating $$IP_{3}$$, ATP and insulin responsible for various functions of $$\beta$$ -cells are still not well understood. Any disturbance in these mechanisms can alter the functions of $$\beta$$ -cells leading to diabetes and metabolic disorders. Therefore, a mathematical model is proposed by incorporating the reaction-diffusion equation for calcium (...) dynamics and a system of first-order differential equations for $$IP_{3}$$, ATP-production and insulin secretion with initial and boundary conditions. The model incorporates the temporal dependence of $$IP_{3}$$ -production and degradation, ATP production and insulin secretion on calcium dynamics in a $$\beta$$ -cell. The piecewise linear finite element method has been used for the spatial dimension and the Crank-Nicolson scheme for the temporal dimension to obtain numerical results. The effect of changes in source influxes and buffers on calcium dynamics and production of $$IP_{3}$$, ATP and insulin levels in a $$\beta$$ -cell has been analyzed. It is concluded that the dysfunction of source influx and buffers can cause significant variations in calcium levels and dysregulation of $$IP_{3}$$, ATP and insulin production, which can lead to various metabolic disorders, diabetes, obesity, etc. The proposed model provides crucial information about the changes in mechanisms of calcium dynamics causing proportionate disturbances in $$IP_3$$, ATP and insulin levels in pancreatic cells, which can be helpful for devising protocols for diagnosis and treatment of various metabolic diseases. (shrink)