Archive for the ‘Medicine’ Category

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Day-O-WIPs 1.0

June 11, 2013

An unprecedented workshop-style afternoon packed with  five different WIPs:

“It is a good thing for every man to know a little about astronomy; it will make him a better man” Nora Boyd

“Boundary Conditions, Laws, and Nomological Content in Quantum Scattering Theory” Bihui Li

“From Waveguides to Field Theory” Michael Miller

“Psychiatric Objects in Research and Practice: Introducing the RDoC”  Kathryn Tabb

“Range Content, Attention, and the Precision of Representation” Trey Boone

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The Use of Usus and the Function of Functio: Teleology and its Limits in Descartes’ Physiology

January 11, 2013
Peter M. Distelzweig
Descartes frequently, explicitly, and controversially rejected appeals to final causes (glossed as divine ends) in natural philosophy. Nonetheless, Descartes employs the apparently teleological language of functio and usus in his physiology. Recently, scholars have given increased attention to the nature, extent, and consistency of this apparent teleology. However, little consensus has emerged. In this paper I examine this interpretive difficulty employing a new, two-pronged strategy. I seek to overcome the potential ambiguities in Descartes language by (1) turning our attention especially to the explanatory structures Descartes uses and by (2) focusing on the medical context of his physiology and the language of usus and functio. I employ work on the concept of ‘function’ in contemporary philosophy of biology in order to clarify my interpretive claims.
I argue that Descartes intends and primarily does employ usus and functio to provide ‘function-analytical’ explanations of the complex behavior of organisms and their organ systems. This was a familiar project, exemplified in (e.g.) the work of Jean Fernel (an influential medical writer of the 16th century). In it, usus are treated like Cummins-functions. Descartes’ goal in his physiology is to provide mechanical explanations to replace the metaphysically more extravagant versions in the medical tradition. I argue further that Descartes, nonetheless, does occasionally employ explanations like the final causal explanations characteristic of the work of anatomists Hieronymus Fabricius ab Aquapendente and his more famous student, William Harvey. In these, usus are treated like Wright-functions. I analyze two examples in Descartes: his explanation of the bicuspid character of the mitral valve of the heart and his explanation of the pscho-corporeal physiology of sensation. Finally, I argue that this kind of explanation is problematic for Descartes’ system: his only explicit strategy for grounding such explanations (appealing to divine non-deceptiveness) has significant difficulties—especially in the case of the mitral valve.
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What is a genetic disease?

October 19, 2012

Marie Darrason (of IHPST, Paris)

The concept of genetic disease originally designated a very restricted class of rare, Mendelian, hereditary, monogenic disorders, such as phenylketonuria. More recently it has come to include common, non–‐Mendelian, non–‐hereditary polygenic disorders such as cancer, diabetes or schizophrenia. Now several authors in the contemporary biomedical literature assert that every disease can be considered genetic and is part of a genetic continuum ranging from simple monogenic Mendelian diseases to complex polygenic disorders.

Philosophers recognize both this geneticization of diseases and the expansion of the concept of genetic disease. They usually propose three interpretations for the shift:

  • either genes are considered the most important causal factor in diseases at the expense of the epigenetic and environmental factors of disease (genocentrism)
  • or this is a heuristic move justified by pragmatic considerations
  • or this is the trivial expression of a weak interactionism where genes and diseases are both considered to be important causal factors in diseases.

Whichever the interpretation they choose, they still try to save the concept of genetic disease. In this presentation, I argue that there is no reason to save the concept of genetic disease, but there is every reason to seek robust explanations of the genetic sides of diseases. To put it in fewer words: the concept of genetic disease is dead, but genetic explanations of disease are not!

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How well do physicians inform surrogate decision-makers about the principles of surrogate decision-making?

October 12, 2012

Thomas Cunningham

Background: Bioethical theory suggests there are three hierarchically ordered standards for surrogated decision-making (SDM): a patient’s advance directive (stated preferences), substituted judgment, or best interests. Empirical studies of SDM indicate flaws in this theory. However, to date, studies have failed to measure the extent to which surrogates are informed about these standards, information that is itself important for understanding ethical SDM in practice. Objective: To measure the extent to which physicians inform surrogates about the normative principles of surrogate decision-making in a sample of 73 ICU family conferences. Methods: An interdisciplinary team of researchers developed a coding framework for assessing values-based surrogate decision-making, including whether ethical standards for surrogate decision-making were explained, discussed, or referred to; two coders then applied the framework to 73 transcribed conferences. Results: In 49% of conferences, physicians did not explicitly explain any of the three principles; in 37% they explained one; in 13% they explained two, and in no conferences (0%) did they explain all three principles. Additional data show that physicians did discuss or refer to the principles in a higher percentage of conferences. Conclusions: Physician-surrogate communication is rich and complex, including some explanation of the principles of surrogate decision-making, but more often only implicit use of them.

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Value, Dysmenorrhea and the Definition of Disease

October 12, 2011

Lauren Ross

Two main philosophical positions contrast the role of value in the definition of disease. The descriptivist position, championed most influentially by Christopher Boorse’s biostatistical theory (BST), claims that the definition of disease should be value-free, an “objective matter” that can be read, more or less, from the scientific facts of nature. The opposing normativist position asserts instead that this definition should involve value, although many different philosophers have widely different conceptions of how exactly it should.

I argue that the Boorsian theory fails to provide a definition of disease that accounts for dysmenorrhea, a disease of severe pelvic pain with menstruation. According to Boorse’s BST an organism is diseased if and only if it experiences subnormal function, with regard to its species, age-group and sex, which impinges upon the organism’s survival or reproductive fitness. The example dysmenorrhea not only fails to fit the BST’s analysis in that it lacks dysfunction and does not reduce survival or reproductive fitness but it also undermines the rationale for that analysis in that its treatment (hysterectomy) diminishes the patient’s survival and reproductive fitness, and does so far more than the disease itself.

Second, I argue for the normativist position in maintaining that the definition of disease must include at least some value because, as demonstrated by the example of dysmenorrhea, it encompasses the notion of suffering—a subjective experience of the patient. Suffering is value-laden because it depends on the patient’s judgment of her condition (its effects on daily life, severity, etc.) and personal preferences (longevity, quality of life, etc.).

My assessment of “value”, in the definition of disease, refers to a subjective assessment of worth made by an individual or collective, and as such, depends on their judgments or preferences. Values are often juxtaposed to objective or empirical scientific facts which, through detached scientific experimentation, provide descriptions of ourselves and our world. Of course whether there is a sharp fact-value distinction is controversial; my argument requires that only a rough distinction of this sort exists and I will not broach the controversies related to the topic.

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What is ‘Group Decision-Making?’

March 25, 2011

Thomas Cunningham

This paper has two goals, motivated by thinking about the “Shared Decision-Making Model” of medical choice (SDM). One, I argue the topic of medical decision-making is an excellent case study in individual and group rationality, which serves well as a case for philosophical reflection. Also, I consider the empirical foundations of SDM and argue that while they sufficiently demonstrate that treatment decisions are social in nature, SDM fails to articulate a normative position for why such decisions should be social rather than simply are social. I conclude by sketching a line of reasoning for providing this missing normative account.

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Defining the “Evidence” in EMB and EBP

February 25, 2011

Lisa Lederer

Nancy Cartwright has been a key figure in the Evidence-Based Policy movement, an effort to formulate philosophically-respectable guidelines for translating social scientists’ conclusions into policy. In his contributions to the Evidence-Based Medicine movement, John Worrall anticipated Cartwright in criticizing how evidence produced from within the scientific community is used outside of it. Worrall’s criticisms are strikingly different from Cartwright’s; while he focuses almost exclusively on methodology in Randomized Controlled Trials, Cartwright’s main concern is more general, with any study that she would call a “method-of-difference” study (after J.S. Mill’s Method of Difference) comparing two groups. Yet although Cartwright’s and Worrall’s main concerns recommend different corrective measures, they derive from the same source: researchers’ inability to identify and understand all the causal factors that produce an effect in the world. Worrall stresses the inevitable existence of unknown causal factors, while Cartwright stresses scientists’ limited knowledge of how even known ones combine. Her defense of the kinds of causal laws uncovered through social science research points to the necessity of “expert judgment” for interpreting these ceteris paribus laws, and thus leaves open the question of just whose expertise is appropriate for predicting their effects in the world. Pace Cartwright, the proper role of philosophers in facilitating the translation of social science results to practice and policy, instead of telling practitioners and policy-makers how to proceed, may be to clarify what kinds of expert judgment they should seek.

*actual quotes taken from the Onion. Just priming you to be careful about your evidence!