Epidemiological models have played a central role in the COVID-19 pandemic, particularly when urgent decisions were required and available evidence was sparse. They have been used to predict the evolution of the disease and to inform policy-making. In this paper, we address two kinds of epidemiological models widely used in the pandemic, namely, compartmental models and agent-based models. After describing their essentials—some real examples are invoked—we discuss their main strengths and weaknesses. Then, on the basis of this analysis, we make (...) a comparison between their respective merits concerning three different goals: prediction, explanation, and intervention. We argue that there are general considerations which could favour any of those sorts of models for obtaining the aforementioned goals. We conclude, however, that preference for particular models must be grounded case-by-case since additional contextual factors, as the peculiarities of the target population and the aims and expectations of policy-makers, cannot be overlooked. (shrink)

The Covid-19 pandemic has challenged both medicine and governments as they have strived to confront the pandemic and its consequences. One major challenge is that evidence-based medicine has struggled to provide timely and necessary evidence to guide medical practice and public policy formulation. We propose an extension of evidence-based corona medicine to an organismic systems corona medicine as a multilevel conceptual framework to develop a robust concept-oriented medical system. The proposed organismic systems corona medicine could help to prevent or mitigate (...) future pandemics by transitioning to a bifocal medicine that extends an empirical evidence-based medicine to a theory-oriented organismic systems medicine. (shrink)

In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for (...) a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis. (shrink)

The concept of moralisation of health behaviours was introduced in social psychology to describe the attribution of moral properties to habits and conditions like smoking or being a vegetarian. Moral properties are powerful motivators for people and institutions, as they may trigger blame, stigma, and appraisal, as well as the polarisation of interest and scientific hype. Here I extend the concept and illustrate how medicines and treatments can be seen as if they had moral properties, too, when they come to (...) be regarded as good or bad in the moral sense, and not just in the instrumental sense of benefiting or harming health. I propose the hydroxychloroquine (HCQ) controversy of 2020 as an example of moralisation of a medicine. HCQ and chloroquine are anti-malarial drugs, whose off-label use for Covid-19 was hotly discussed in the early months of the pandemic, both in the media and within the scientific community, and eventually dismissed when robust evidence came out. The point of the paper is to show that moralisation of health products and treatments may influence individual and institutional decisions in significant ways, and also affect research. For these reasons, it should be carefully monitored and critically assessed. (shrink)

Scientific models can be performative: they can causally affect the phenomena they are intended to represent. The existing literature offers two responses. The appraisal view emphasizes that performativity can sometimes be a good-making model attribute, e.g., when predictions steer the public’s behavior in desirable ways. The mitigation view seeks to endogenize agents’ behavioral response to model-issued forecasts to get rid of performativity instead. This paper argues that neither approach is fully compelling: the appraisal view encounters severe concerns about moral values (...) illegitimately encroaching on how modelers construct and use models, while the mitigation view fails to acknowledge that endogenization is itself a choice that involves substantive value-judgments relating to the desirability of certain social outcomes. (shrink)

In a scenario characterized by unpredictable developments, such as the recent COVID-19 pandemic, epidemiological models have played a leading part, having been especially widely deployed for forecasting purposes. In this paper, two real-world examples of modeling are examined in support of the proposition that science can convey inconsistent as well as genuinely perspectival representations of the world. Reciprocally inconsistent outcomes are grounded on incompatible assumptions, whereas perspectival outcomes are grounded on compatible assumptions and illuminate different aspects of the same object (...) of interest. In both cases, models should be viewed as expressions of specific assumptions and unconstrained choices on the part of those designing them. The coexistence of a variety of models reflects a primary feature of science, namely its pluralism. It is herein proposed that recent over-exposure to science’s inner workings and disputes such as those pertaining to models, may have led the public to perceive pluralism as a flaw—or more specifically, as disunity or fragmentation, which in turn may have been interpreted as a sign of unreliability. In conclusion, given the inescapability of pluralism, suggestions are offered as to how to counteract distorted perceptions of science, and thereby enhance scientific literacy. (shrink)

This article is an introduction to the special issue on philosophy of medicine. Philosophy of medicine is a field that has flourished in the last couple of decades and has become increasingly institutionalized. The introduction begins with a brief overview of some of the most central recent developments in the field. It then describes the six articles that comprise this issue.