Only a few studies explore the lifeworld of the spouses of persons affected by early-onset Alzheimer disease. The aim of this study is to explore the lifeworld of spouses when their partners are diagnosed with AD, focusing on spouses’ lived experience. The study employs an interpretative phenomenological framework. Ten in-depth interviews are performed. The results show that spouses’ lifeworld changes with the diagnosis. They experience an imprisoned existence in which added obligations, fear, and worry keep them trapped at home, (...) both physically and mentally. In their longing for freedom, new strategies and attitudes helps the spouses to create an extended “lived space” with their partner. The findings stress the importance of paying attention to the lifeworld of spouses and making clinical recommendations on this basis. Most importantly, the lifeworld perspective has implications for how we understand what care is. We hope to challenge all different healthcare professionals and invite them to discuss the deep meaning of care and the definition of being professional in encounters with vulnerable others from a lifeworld perspective. (shrink)

_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by (...) the combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

It is argued that there is no agreed definition of disease. Purely biological definitions are inadequate and combined biological and social definitions are not yet satisfactory. One approach has been to say that what doctors treat is disease. We are uncomfortable with that because we feel it releases people from obligations on a basis of convenience. In practice the weight given to the idea of disease varies according to what it will imply about obligations and privileges. It (...) is suggested that what doctors treat can be accepted as disease provided that we recognize that the significance of disease must vary with circumstances. Those circumstances include the agreement, more or less, of all persons affected when someone is considered to be a patient. The individual must also be competent and not constrained except by his own biological or psychological characteristics. Keywords: disease, patient-physician relationship, obligation CiteULike Connotea Del.icio.us What's this? (shrink)

This paper contends, following Plato and Broekman, that seeing images as images is crucial to theorizing medicine and that considering clinical pictures as images of images is a much-needed epistemic complement to the domineering view that sees clinical pictures as mirrors of disease. This does not only offer epistemic, but also ethical benefits to individual patients, especially in those cases where patients suffer from chronic, debilitating, and terminal illnesses and where medicine provides no, or limited, answers in terms of (...) treatment, intervention, and meaning. By creating room for a theory of clinical pictures that rightfully emphasizes its pictorial nature, patients and doctors alike may be encouraged to consider under what authorship, and with which epistemic tools, alternative, supplemental images may be produced to get at the existential reality of disease and suffering. Ultimately, this paper argues that the epistemic tools provided by aesthetics may offer such glimpses into the reality of disease and suffering, and I conclude by discussing a few artistic renditions of breast cancer to illustrate my point. (shrink)

In describing and explaining the sexes, medicine and science participated in the delineation of what was "feminine" and what was "masculine" in the Middle Ages. Hildegard of Bingen and Albertus Magnus, among others, writing about gynecology, the human constitution, fetal development, or the naturalistic dimensions of divine Creation, became increasingly interested in issues surrounding reproduction and sexuality. Did women as well as men produce procreative seed? How did the physiology of the sexes influence their healthy states and their susceptibility to (...) disease? Who derived more pleasure from sexual intercourse, men or women? The answers to such questions created a network of flexible concepts which did not endorse a single model of male-female relations, but did affect views on the health consequences of sexual abstinence for women and men and on the allocation of responsibility for infertility - problems with much social and religious significance in the Middle Ages. Sometimes at odds with, and sometimes in accord with other forces in medieval society, medicine and natural philosophy helped to construct a set of notions that divided significant portions of the world - from the behavior of animals to the operations of astrological signs - into "masculine" and "feminine." Even cases that seemed to exist outside the definitions of this duality, for example, hermaphrodite features or homosexual behavior, were brought under control by the application of gendered labels, such as "masculine women.". (shrink)

A more specific meaning of may be derived from the noun which in the modern Greek dialect of Epirus indicates some type of disease that leaves the scalp at least partially bare of its hair. It is often used with words such as psoriasis, or meaning, possibly, a disease caused by a type of ringworm which destroys the hair of the scalp. At present it is still used in mostly derogatory expressions, or in curses, such as: (...) ‘Psoriasis and ringworm have eaten him up’ or, ‘May psoriasis and ringworm eat you up!’In the Odyssey, where the word occurs, Odysseus, disguised by Athena as a wretched old beggar, is also deprived of his hair. This may perhaps have caused the inference to the ringworm disease and / or baldness in both passages where the epithet appears in Homer. (shrink)

A more specific meaning of may be derived from the noun which in the modern Greek dialect of Epirus indicates some type of disease that leaves the scalp at least partially bare of its hair. It is often used with words such as psoriasis, or meaning, possibly, a disease caused by a type of ringworm which destroys the hair of the scalp. At present it is still used in mostly derogatory expressions, or in curses, such as: (...) ‘Psoriasis and ringworm have eaten him up’ or, ‘May psoriasis and ringworm eat you up!’ In the Odyssey, where the word occurs, Odysseus, disguised by Athena as a wretched old beggar, is also deprived of his hair. This may perhaps have caused the inference to the ringworm disease and / or baldness in both passages where the epithet appears in Homer. (shrink)

Der Beitrag befasst sich mit religiösen Deutungen von Krankheit und ihren ethischen Implikationen, und zwar aus einer christlichen Perspektive. Er problematisiert die verbreitete Auffassung, dass Religion es ermöglicht, Kontingenzerfahrungen wie eine Krankheit mit einem Sinn zu verbinden und dadurch in das eigene Leben zu integrieren. Das Spezifische religiöser Deutungen und Praktiken liegt eher darin, dass sie es ermöglichen, mit Sinnlosigkeit zu leben. Sie haben dabei ethische Implikationen in Bezug auf den Umgang mit Krankheit und Sterben.

In the discussion of such social questions as "how should alcoholics be treated by society?" and "what kind of people are responsible in the face of the law?", is "disease" a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance 'alcoholism should be classified as a disease' we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases (...) and, therefore, we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden. (shrink)

Ausgehend von Kleinmans Differenzierung des Krankheitsbegriffs in disease, illness und sickness und der Unterscheidung von Krankheit und Behinderung durch die Weltgesundheitsorganisation wird am Beispiel von Aufmerksamkeitsstörungen untersucht, welche Zusammenhänge zwischen den beiden Konzeptionen, Krankheit und Behinderung, bestehen. Hierbei wird gefragt, ob und wie Kleinmans Differenzierung des Krankheitsbegriffs auf den Behinderungsbegriff übertragen werden kann und wie eine Modifizierung produktiv für das Verständnis konkreter Syndrome genutzt werden kann. Während die WHO seit 1980 Behinderung von Krankheit auch per Klassifikation unterscheidet, ist der (...) Bereich chronischer Erkrankungen und psychischer sowie kognitiver Syndrome nicht eindeutig verortet. Dies zeigt sich u. a. daran, dass Intelligenzminderungen und Aufmerksamkeitsstörungen (als spezielle Form hyperkinetischer Störungen) sowohl medizinisch mit der ICD-10 (als Krankheitsklassifikation) diagnostiziert als auch mit der Behinderungsklassifikation der WHO, der Internationalen Klassifikation von Funktionsfähigkeit, Behinderung und Gesundheit (ICF), klassifiziert werden können. Im Gegensatz zur ICD lassen sich die Syndrome mit der ICF differenziert kategorisieren, dadurch dass einzelne Körperfunktionen oder Aktivitäten sowie die individuelle Umwelt beurteilt werden. Aufmerksamkeitsschwierigkeiten sowie verschiedene kognitive Fähigkeiten können interdisziplinär beurteilt werden, indem sowohl ihre physischen und psychischen als auch ihre individuellen und gesellschaftlichen Komponenten berücksichtigt werden. Die fachliche und die persönliche Perspektive auf die Syndrome sollten miteinander korreliert werden. Eine klare konzeptionelle Unterscheidung von Krankheit und Behinderung ist nicht möglich. (shrink)

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, and curing disease are (...) core aims, but also to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates (a) what is meant by these claims (b) what their implications are, and (c) whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

The sudden arrival of the coronavirus disease 2019 (COVID-19) pandemic in South Africa drastically changed the normal way of life in all sectors. It compelled everyone to look at the meaning of life and death differently and more painfully than before. This article investigates the cultural theories and religious narratives on the meaning of life and death, associated with the pervasiveness of the COVID-19 pandemic. The coronavirus affected individuals, families and communities, some directly or indirectly, no one (...) is or was immune to the virus. The article argues that due to COVID-19 restrictions and lockdowns, culture, religious practices and protocols have been upended. The COVID-19 pandemic challenged inkcubeko nenkolo yabantu [culture, people’s religious belief systems and practices]. This article consists of in-depth qualitative interviews with four religious leaders from the Christian and Muslim faiths. Because of the interviews with persons, oral historians conduct open-ended interviews, as a form of social inquiry. Oral history narratives thus connect the individual and the social, drawing on cultural and religious expressions to tell one’s story. Contribution: The scholarly contribution of this article adds value and significance to oral history research, as a way of collecting and interpreting human memories and experiences on the meaning of life and death during the COVID-19 crisis. It discusses the dreadfulness of the COVID-19 scourge concerning religious and cultural effects, social sciences and people’s narrative reflections. (shrink)

Identifying the necessary and sufficient conditions for individuating and classifying diseases is a matter of great importance in the fields of law, ethics, epidemiology, and of course, medicine. In this paper, I first propose a means of achieving this goal, ensuring that no two distinct disease-types could correctly be ascribed to the same disease-token. I then posit a metaphysical ontology of diseases—that is, I give an account of what a disease is. This is essential to providing the (...) most effective means of interfering with disease processes. Following existing work in the philosophy of medicine and epidemiology (primarily Christopher Boorse; Caroline Whitbeck; Alexander Broadbent), philosophy of biology (Joseph LaPorte; D.L. Hull), conditional analyses of causation (J.L. Mackie; David Lewis), and recent literature on dispositional essentialism (Stephen Mumford and Rani Anjum; Alexander Bird), I endorse a dispositional conception of disease. Following discussion of various conceptions of disease-identity, their relations to the clinical and pathological effects of the diseases in question, and how diseases are treated, I conclude (i) that diseases should be individuated by their causes, and (ii) that diseases are causal processes best seen as simultaneously acting sequences of mutually manifesting dispositions. (shrink)

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

In the discussion of such social questions as how should alcoholics be treated by society? and what kind of people are responsible in the face of the law?, is disease a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance alcoholism should be classified as a disease we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases, (...) and therefore we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden. (shrink)

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, and curing disease are (...) core aims, but also to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates what is meant by these claims, what their implications are, and whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

This essay argues that philosophical phenomenology can provide important insights into the patient-physician relationship. In particular, it is noted that the physician and patient encounter the experience of illness from within the context of different "worlds", each "world" providing a horizon of meaning. Such phenomenological notions as focusing, habits of mind, finite provinces of meaning, and relevance are shown to be central to the way these "worlds" are constituted. An eidetic interpretation of illness is proposed. Such an interpretation (...) discloses certain essential characteristics that pertain to the experience of illness, per se , regardless of its manifestation in terms of a particular disease state. It is suggested that, if a shared world of meaning is to be constituted between physician and patient, the eidetic characteristics of illness must be recognized by the physician. Keywords: phenomenology, patient-physician relationship, illness-as-lived, habits of mind, relevance, eidetic CiteULike Connotea Del.icio.us What's this? (shrink)

Naturalistic theories of disease appeal to concepts of biological function, and use the notion of dysfunction as the basis of their definitions. Debates in the philosophy of biology demonstrate how attributing functions in organisms and establishing the function-dysfunction distinction is by no means straightforward. This problematization of functional ascription has undermined naturalistic theories and led some authors to abandon the concept of dysfunction, favoring instead definitions based in normative criteria or phenomenological approaches. Although this work has enhanced our understanding (...) of disease and illness, we need not necessarily abandon naturalistic concepts of function and dysfunction in the disease debate. This article attempts to move towards a new naturalistic theory of disease that overcomes the limitations of previous definitions and offers advantages in the clinical setting. Our approach involves a reevaluation of concepts of biological function employed by naturalistic theories. Drawing on recent insights from the philosophy of biology, we develop a contextual and evaluative account of function that is better suited to clinical medicine and remains consistent with contemporary naturalism. We also show how an updated naturalistic view shares important affinities with normativist and phenomenological positions, suggesting a possibility for consilience in the disease debate. (shrink)

It is fundamental assumption in nursing theory that it is important for nurses to understand how patients experience states of ill health. This assumption is often related to aims of empathic understanding, but normative principles of social interpretation can have an important action‐guiding role whenever nurses seek to understand patients’ subjective horizons on the basis of active or passive expressions of meaning. The aim of this article is to present a philosophical theory of concept possession and to argue that (...) it can shed light on how nurses should seek to understand patients’ subjective perspectives on the meaning of illness. The two basic ideas in the theory are that patients’ beliefs and thoughts about their experiences involve concepts and that concepts can be communicated on the basis of shared implicit conceptions of what they mean. These conditions of understanding have a striking application: nurse‐patient communication is limited by many contextual factors, but it is often possible for nurses to detect shared implicit conceptions of the meaning of concepts of disease and illness. Furthermore, by acting as sympathetic linguistic experts and creating an atmosphere for dialogue, nurses can make patients feel comfortable about deferring to medical explanations of meaning that can constitute a communicative platform. The last part of the article uses a number of cases studies to show how these implications can be implemented as conceptual tools for securing meaningful communication about illness experiences in patient dialogue. (shrink)

Abstract: The study investigates philosophically the issue of human illness and its organic pertinence to the meaning of human life starting from the recognition that the dangerous encounter with the experience of illness is an unavoidable – and as such crucial – experience of the life of any living being. As for us humans, there is probably no mortal man who has never suffered of some – any! – kind of disease from his birth to the end of (...) his life… Illness is therefore an experience or outright a danger of existence and its possibility, as well as a way of being that nobody has ever been and will ever be ontologically or existentially exempted from. So, it may well be “arbitrary” or “accidental” which disease affects which being or person, when and to what degree, in what way, etc., but it is factually unavoidable that in the course of one’s entire life – from its very beginning to its very end – one would never fall ill in some respect. The paper discusses this issue by the ontological investigation of possibility. (shrink)

The ongoing COVID-19 pandemic has brought science to the fore of public discourse and, considering the complexity of the issues involved, with it also the challenge of effective and informative science communication. This is a particularly contentious topic, in that it is both highly emotional in and of itself; sits at the nexus of the decision-making process regarding the handling of the pandemic, which has effected lockdowns, social behaviour measures, business closures, and others; and concerns the recording and reporting of (...) disease mortality. To clarify a point that has caused much controversy and anger in the public debate, the first part of the present article discusses the very fundamentals underlying the issue of causative attribution with regards to mortality, lays out the foundations of the statistical means of mortality estimation, and concretizes these by analysing the recording and reporting practices adopted in England and their widespread misrepresentations. The second part of the article is empirical in nature. I present data and an analysis of how COVID-19 mortality has been reported in the mainstream media in the UK and the USA, including a comparative analysis both across the two countries as well as across different media outlets. The findings clearly demonstrate a uniform and worrying lack of understanding of the relevant technical subject matter by the media in both countries. Of particular interest is the finding that with a remarkable regularity (????>0.998), the greater the number of articles a media outlet has published on COVID-19 mortality, the greater the proportion of its articles misrepresented the disease mortality figures. (shrink)

Naturalistic theories of disease appeal to concepts of biological function, and use the notion of dysfunction as the basis of their definitions. Debates in the philosophy of biology demonstrate how attributing functions in organisms and establishing the function-dysfunction distinction is by no means straightforward. This problematization of functional ascription has undermined naturalistic theories and led some authors to abandon the concept of dysfunction, favoring instead definitions based in normative criteria or phenomenological approaches. Although this work has enhanced our understanding (...) of disease and illness, we need not necessarily abandon naturalistic concepts of function and dysfunction in the disease debate. This article attempts to move towards a new naturalistic theory of disease that overcomes the limitations of previous definitions and offers advantages in the clinical setting. Our approach involves a re-evaluation of concepts of biological function employed by naturalistic theories. Drawing on recent insights from the philosophy of biology, we develop a contextual and evaluative account of function that is better suited to clinical medicine and remains consistent with contemporary naturalism. We also show how an updated naturalistic view shares important affinities with normativist and phenomenological positions, suggesting a possibility for consilience in the disease debate. (shrink)

Identifying the necessary and sufficient conditions for individuating and classifying diseases is a matter of great importance in the fields of law, ethics, epidemiology, and of course medicine. In this paper I first propose a means of achieving this goal, ensuring that no two distinct disease-types could correctly be ascribed to the same disease-token. I then posit a metaphysical ontology of diseases - that is, I give an account of what a disease is. This is essential to (...) providing the most effective means of interfering with disease processes. Following existing work in the philosophy of medicine and epidemiology, philosophy of biology, conditional analyses of causation, and recent literature on dispositional essentialism, I endorse a dispositional conception of disease whereby diseases are individuated by their causes, and diseases are causal processes best seen as simultaneously acting sequences of mutually manifesting dispositions - this, I claim, follows from the assumption that diseases should be classified by consideration of both their clinical and pathological effects, and importantly, events that can lead to the cessation of these symptoms. (shrink)

Public health is a dynamic field. Outbreaks of new diseases, as well as changing patterns of population growth, economic development, and lifestyle trends all may threaten public health and thus demand a public health response. As the practice of public health evolves, there is an ongoing need to reassess its scientific, ethical, legal, and social underpinnings. Such a reappraisal must consider the disagreement among public health officials, public health scholars, elected officials, and the public about the proper role of public (...) health and the distinctions, for example, between public health and clinical care, and public health and health promotion.In this article I will attempt to characterize the main points of contention as well as offer my own views regarding the proper scope of public health. Greater clarity and consensus on the meaning of public health are likely to lead to more efficient and effective public health interventions as well as increased public and political support for public health activities. (shrink)

Public health is a dynamic field. Outbreaks of new diseases, as well as changing patterns of population growth, economic development, and lifestyle trends all may threaten public health and thus demand a public health response. As the practice of public health evolves, there is an ongoing need to reassess its scientific, ethical, legal, and social underpinnings. Such a reappraisal must consider the disagreement among public health officials, public health scholars, elected officials, and the public about the proper role of public (...) health and the distinctions, for example, between public health and clinical care, and public health and health promotion.In this article I will attempt to characterize the main points of contention as well as offer my own views regarding the proper scope of public health. Greater clarity and consensus on the meaning of public health are likely to lead to more efficient and effective public health interventions as well as increased public and political support for public health activities. (shrink)

Resumen En el presente trabajo se investigan los alcances y las consecuencias que se desprenden de utilizar a Heidegger en el campo de la filosofía de la medicina. Con este fin, la investigación se divide en los siguientes puntos: 1) se explicitará en qué puede consistir una “antropologización” del pensamiento heideggeriano; 2) se ofrecerá una descripción general respecto de las teorías de la salud y enfermedad más significativas y actuales en el campo de la teoría de la medicina; 3) nos (...) detendremos en el análisis relacionado con el problema de la enfermedad desde una perspectiva heideggeriana, para finalmente, 4) ofrecer algunas reflexiones críticas en relación con el análisis ofrecido.In this contribution we investigate the scope and consequences that arise from applying Heidegger in the field of philosophy of medicine. For this purpose, the paper is divided in the following points: First, we will make explicit the meaning of an “anthropologization” of Heidegger's thought. Second, an overview of the most significant contemporary theories of health and disease in the field of theory of medicine will be offered. Third, we will interpret the meaning of disease from a Heideggerian perspective. Finally, 4) we will offer some critical reflections offered in relation to the analysis. (shrink)

The convergence of biomedical sciences with nanotechnology as well as ICT has created a new wave of biomedical technologies, resulting in visions of a ‘molecular medicine’. Since novel technologies tend to shift concepts of disease and health, this paper investigates how the emerging field of molecular medicine may shift the meaning of ‘disease’ as well as the boundary between health and disease. It gives a brief overview of the development towards and the often very speculative visions (...) of molecular medicine. Subsequently three views of disease often used in the philosophy of medicine are briefly discussed: the ontological or neo-ontological, the physiological and the normative/holistic concepts of disease. Against this background two tendencies in the field of molecular medicine are highlighted: (1) the use of a cascade model of disease and (2) the notion of disease as a deviation from an individual pattern of functioning. It becomes clear that molecular medicine pulls conceptualizations of disease and health in several, partly opposed directions. However, the resulting tensions may also offer opportunities to steer the future of medicine in more desirable directions. (shrink)

Causation has multiple distinct meanings in genetics. One reason for this is meaning slippage between two concepts of the gene: Mendelian and molecular. Another reason is that a variety of genetic methods address different kinds of causal relationships. Some genetic studies address causes of traits in individuals, which can only be assessed when single genes follow predictable inheritance patterns that reliably cause a trait. A second sense concerns the causes of trait differences within a population. Whereas some single genes (...) can be said to cause population-level differences, most often these claims concern the effects of many genes. Polygenic traits can be understood using heritability estimates, which estimate the relative influences of genetic and environmental differences to trait differences within a population. Attempts to understand the molecular mechanisms underlying polygenic traits have been developed, although causal inference based on these results remains controversial. Genetic variation has also recently been leveraged as a randomizing factor to identify environmental causes of trait differences. This technique—Mendelian randomization—offers some solutions to traditional epidemiological challenges, although it is limited to the study of environments with known genetic influences. (shrink)

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused (...) on the task of delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be? (shrink)

In this article, I draw on my fieldwork creating protein models of hepatitis B at a biotech laboratory to think through how to approach the body and disease from ontological and phenomenological perspectives. I subsequently draw on Mariella Pandolfi’s work on how bodies can be made to suffer history and Paul Farmer’s work on global tuberculosis disparities to explore ways of analysing embodied activity as a means of identifying and clinically addressing enactments of social inequality and disease. I (...) also introduce Merleau-Ponty’s phenomenological concept of ‘flesh’ as a conceptual heuristic that allows us to understand the meaningful structuring of ontological worlds beyond our own. As I argue, bringing these perspectives together not only allows us to re-envision what an effective disease treatment should be in diverse medical contexts, but also how to better understand health disparities and the nature of disease itself. (shrink)

SummaryThe meaning of the term “health” is properly the subject of social, rather than natural, investigation. The structure of modern industrial capitalist society appears to materially and unavoidably produce a meaning of “health” intrinsically involving substantially preventable disease. Because in such a society private investment responds to cyclical and geographic fluctuations in rates of return and competitive labor markets, much of the disease structure (heart disease, stroke, kidney failure, and cancer, among others) encompasses diseases which (...) captive citizens cannot afford to do without. To prevent those diseases through environmental and workplace cleanup, full employment and geographic capital stability is to drive away the very private capital on which economic life is based. Consequently, those diseases are as intrinsic to modern capitalist society as the law of supply and demand and are, therefore, a characteristic component of the meaning of “health,” the socially optimum level of organismic condition, in this epoch. A necessary condition for the emancipation of “health” from socially preventable disease would appear to be the social, rather than private, control of production and accumulation. (shrink)

According to the US National Institute on Aging and the Alzheimer’s Association (NIA-AA), Alzheimer’s disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AA’s conceptualisation of AD radically challenges past AD conceptualisations. This article offers ananalytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that (...) of AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as “biological-physiological” or “normative” conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation. (shrink)

In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of (...) disease, I configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008 , 783). (shrink)

The oncological disease experience is counted as a wound in the body and mind attributable to a traumatic experience that fragments and disorients the person’s biography. The neoplasia leaves marks and scars in both somatic and existential level. The illness experience suggests to patient to look for meaning that cannot be unheard. The literature associating the concept of liminality in oncological disease to understand the process of meaning making. The definition of new horizons of meaning, (...) generated by crossing the limen, opens up a new self-awareness and worldview. The autopoietic dimension present in oncological disease reveals new scenarios of generativity and existential planning in the direction of self-realization in the cipher of the possible. The contribution presents the story of Anastasia, a 41-years-old nurse. A few months after her new marriage and close to a professional promotion, she receives the diagnosis of cholangiocarcinoma: a very aggressive, low-incidence, neoplasia, without specific therapeutic lines and with a negative prognosis. Anastasia’s words, thoughts and emotions, collected in the course of some testimonies in a university classroom, are analyzed and deciphered within the pedagogical paradigm, refering to the perspective of pedagogical problematicism and phenomenological pedagogy. (shrink)

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. (...) According to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

In this book, psychiatrist Thomas Szasz returns to familiar subjects—the collusion between state and medical authorities, the social construction of mental disease—linking them with some other recent topics: so-called False Memory Syndrome and the modern erosion of individual responsibility. Szasz’s central and unifying thesis is that there is no such thing as the mind; he recommends, rather, that we focus on the concept of minding, where this encompasses a host of cognitive operations, including intentionality, thinking, remembering, pondering, and reasoning. (...) Misunderstanding “the” mind as an entity encourages mind-brain identification, gives rise to the concepts of mental illness and disease, thereby legitimating various treatments, and serves to prevent the attribution of responsibility to those who are, in fact, responsible for their behaviour. In a discussion that sweeps from the ancient Greeks through the Middle Ages to Descartes, and finally to contemporary neuroscience, Szasz contends that we have shifted from attributing minding to too much in nature to failing to attribute minding at all. He charges that a combination of brain research and bad philosophy—the Churchlands come in for considerable criticism—has rendered the concepts of the person and of personal responsibility close to otiose. (shrink)

For ages, natural disasters, war and disease have been part of life, sharing themes of not only adversity, fear and death, but also hope. The year 2020 brought a new threat in the form of coronavirus disease 2019, which challenged what humankind understood of all they knew and believed. The significant difference today is the role of the media in sharing news and opinions on this disease that threatens not only lives, but also spiritual well-being. In this (...) study, we focus on people’s religious views on the origin and meaning of this invisible threat to establish how this pandemic impacts on people’s belief systems. The 20th century was marked by a shift whereby actions and events are intellectualised to rationalise cause and effect, and the philosophical theodicies are regarded to limit our critical reasoning. This study, however, shows that COVID-19 reactivates this debate in that it surpasses logic and rational thinking. Data are collected by means of comments, discussions and opinions shared on numerous social media platforms. During times of adversity, the same rhetorical ‘who’ and ‘why’ questions are asked and in this regard, theodicy as a philosophical framework informs this study. Applying a narrative inquiry, data are interpreted and three themes are identified, namely COVID-19 is an act God, COVID-19 has nothing to do with God and God remains in control amidst a devastating pandemic. The sample for this study is random and the medium used allows for representativity in terms of age group, gender, race, religious affiliation of South Africa, but not limited to this country.Contribution: This article provides insight into renewed debates on religious views on pandemics and suffering in the context of COVID-19. It contributes to an understanding of different perceptions on the origin of this disease, how people make sense and find meaning in being part of a global discourse. (shrink)

Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. (...) Drawing on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms. (shrink)

Currently, there is a growing interest in combining genetic information with physiological data measured by functional neuroimaging to investigate the underpinnings of psychiatric disorders. The first part of this paper describes this trend and provides some reflections on its chances and limitations. In the second part, a thought experiment using a commonsense definition of psychiatric disorders is invoked in order to show how information from this kind of research could be used and potentially abused to invent new mental illnesses. It (...) is then argued why an inference to the best explanation could provide an antidote to such attempts. The conclusion emphasises why normative criteria, such as those used to define disorders, cannot be derived from descriptive empirical results alone. While the etiology of some psychiatric diseases may be purely organic, there are many other cases where the psychiatric symptoms and the associated genotypes and phenotypes have an essentially and irreducibly external meaning that is derived from social and political factors. A limited perspective on the genes and brain of man carries the risk that psychiatry may increasingly treat the effects of other domains, although social and political solutions would be more appropriate. (shrink)

The biopsychosocial model was initially proposed to overcome the normative assumption that human diseases are exclusively due to disordered biochemical and/or neurophysiological processes. The model attempts to explain how expectations, thoughts and feelings modify the patient’s motivations to deal with illness and recovery. By considering the physical health in this perspective, healthcare professionals may test the importance of socially and culturally shared principles in alleviating illness experience. The entire biopsychosocial hierarchy may thus appear as a complex network of relationships between (...) the strict logic of scientific explanations and the emotional sustainability with which beliefs may either be defended, changed or even refused. In this paper, we aim at reviewing some of the evidence-based biomedical and psychological findings that provide a unified framework for the biopsychosocial model as a multilevel integrative process. To tackle this objective, we propose to approach the model in biosemiotic terms. It is our contention that the entire biopsychosocial hierarchy could be better understood if approached biosemiotically and the multilevel interconnection of this hierarchy re-examined in the light of a collaborative meaning-making process. (shrink)