In this paper I shall try to analyse appropriate logic and actual methods as a preliminary to developing expert systems that will simulate clinical diagnosis. It is doubtful that all diagnoses address the same kind of problem and hence no one logic will suffice. Sometimes the signs and symptoms manifest an underlying disorder that cannot be observed directly (the substantialist model); sometimes there seems to be no underlying disorder and the diagnosis is a rearrangement of the data (the nominalist model). (...) In deciding their merits in the particular case, we must identify the sources of variation; what is meant by saying that the data are independent; and what can be meant by wrong diagnosis and misclassification. Problems arise in human diagnosis because the data may be false, even lies; because the known list of diseases is not exhaustive; and because the probability of multiple unrelated diseases increases with age. Special difficulties arise from homeostasis (which is fundamental in defining and understanding disease) because the primary disturbances may be hard to distinguish from the homeostatic responses to them. (shrink)

Background: Causal reasoning as a way to make a diagnosis seems convincing. Modern medicine depends on the search for causes of disease and it seems fair to assert that such knowledge is employed in diagnosis. Causal reasoning as it has been presented neglects to some extent the conception of multifactorial disease causes. Goal: The purpose of this paper is to analyze aspects of causation relevant for discussing causal reasoning in a diagnostic context.

In medical diagnostic examination three main stages may be distinguished: (a) initial exploration, (b) hypothesis-directed investigation, and (c) final diagnosis making. The purpose of this work is to study some methodological problems concerning the second of the above stages of the diagnosis and to prepare a background for a mathematical model [30] of this process.In diagnostic problem solving, the reasoning proceeds along the main lines traced by some initial suggestions and passes through various intermediate elements which are (...) connected with one another forming ramifying chains and nets of inferences and hypotheses. Such a complex mental construction is based on laws which form medical knowledge and reflect various regularities and relations, causal, structural, functional, and others. (shrink)

A diagnostic judgment of a teacher can be seen as an inference from manifest observable evidence on a student’s behavior to his or her latent traits. This can be described by a Bayesian model of in-ference: The teacher starts from a set of assumptions on the student (hypotheses), with subjective probabilities for each hypothesis (priors). Subsequently, he or she uses observed evidence (stu-dents’ responses to tasks) and knowledge on conditional probabilities of this evidence (likelihoods) to revise these assumptions. Many (...) systematic deviations from this model (biases, e.g. base-rate neglect, inverse fallacy) are reported in literature on Bayesian reasoning. In a teacher’s situation the information (hypotheses, priors, likelihoods) is usually not explicitly represented numerically (as in most research on Bayesian reasoning), but only by qualitative esti-mations in the mind of the teacher. In our study, we ask to which extent individuals (approximately) apply a rational Bayesian strategy or resort on other biased strategies of processing information for their diagnostic judgments. We explicitly pose this question with respect to non-numerical settings. To investigate this question, we developed a scenario that visually displays all relevant information (hypotheses, priors, likelihoods) in a graphically displayed hypothesis space (called “hypothegon”) – without recurring to numerical representations or mathematical procedures. 42 pre-service teach-ers were asked to judge the plausibility of different misconceptions of six students based on their responses to decimal comparison tasks (e.g. 3.39 > 3.4). Applying a Bayesian classification proce-dure, we identified three updating strategies: A Bayesian update strategy (BUS, processing all probabilities), a combined evidence strategy (CES, ignoring the prior probabilities but including all likelihoods), and a single evidence strategy (SES, only using the likelihood of the most probable hypothesis). In study 1, an instruction on the relevance of using all probabilities (priors and likelihoods) only weakly increased the processing of more information. In study 2, we found strong evidence that a visual explication of the prior-likelihood interaction led to an increase of processing the interaction of all relevant information. These results show that the phenomena found in general research on Bayesian reasoning in numerical settings extend to diagnostic judgments in non-numerical settings. (shrink)

The presence and role of microbes in human cancers has come full circle in the last century. Tumors are no longer considered aseptic, but implications for cancer biology and oncology remain underappreciated. Opportunities to identify and build translational diagnostics, prognostics, and therapeutics that exploit cancer's second genome—the metagenome—are manifold, but require careful consideration of microbial experimental idiosyncrasies that are distinct from host‐centric methods. Furthermore, the discoveries of intracellular and intra‐metastatic cancer bacteria necessitate fundamental changes in describing clonal evolution and selection, (...) reflecting bidirectional interactions with non‐human residents. Reconsidering cancer clonality as a multispecies process similarly holds key implications for understanding metastasis and prognosing therapeutic resistance while providing rational guidance for the next generation of bacterial cancer therapies. Guided by these new findings and challenges, this Review describes opportunities to exploit cancer's metagenome in oncology and proposes an evolutionary framework as a first step towards modeling multispecies cancer clonality. Also see the video abstract here: https://youtu.be/-WDtIRJYZSs. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for (...) a shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Aims: The Research Diagnostic Criteria for Temporomandi¬bular Disorders (RDC/TMD) Axis I diagnostic algorithms were demonstrated to be reliable but below target sensitivity and specificity. Empirical data supported Axis I algorithm revisions that were valid. Axis II instruments were shown to be both reliable and valid. An international consensus workshop was convened to obtain recommendations and finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: A comprehensive search of published TMD diagnostic literature was (...) followed by review and consensus via a formal structured process by a panel of experts for revision of the RDC/TMD. Results: The recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for pain diagnoses and valid criteria for the most common pain-related TMDs and for one intra-articular disorder. The Axis II protocol retains selected RDC/TMD screening instruments augmented with new instruments to better assess the interactions between pain and psychosocial functioning. A comprehensive classification system is also presented. Conclusion: The recommended evidence-based DC/TMD protocol is appropriate for use in both the clinical and research settings. Simple Axis I and II screening tests augmented by validated Axis I and Axis II instruments allow for identification of simple to complex TMD patients. (shrink)

“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large and medicine in particular; it has important implications for the process of diagnostics. Because genetic diagnostics produces knowledge about genetic disease and predisposition to disease, it is essentially influenced by these innovations in the disease concept. In this paper, I argue that genetic diagnostics presents new ethical challenges not because the diagnostic process or method in genetic diagnostics (...) is ethically different in kind from traditional medical diagnostics, but because it relies on a neo-ontological concept of disease in a context of genetic reductionism. Geneticization has not produced a radically new concept of disease, however, but has introduced innovations into the classical ontological concept of disease. When this new concept of disease is held in tandem with genetic reductionism, we are led to the absurd conclusion that disease is the very essence of the human being. I argue that neither the neo-ontological concept of disease nor genetic reductionism is necessary for a proper understanding of genetic diagnostics. (shrink)

The target article focuses exclusively on System 2 and on reasoning rationality: the ability to reach valid conclusions from available information, as in the Wason task. The decision-theoretic concept of coherence rationality requires beliefs to be consistent, even when they are assessed one at a time. Judgment heuristics belong to System 1, and help explain the incoherence of intuitive beliefs.

Diagnostic errors are more frequently a result of the clinician's failure to combine medical knowledge adequately than of data inaccuracy. Diagnostic reasoning studies are valuable to understand and improve diagnostic reasoning. However, most diagnostic reasoning studies are characterized by some limitations which make these studies seem more simple than diagnostic reasoning in real life situations actually is. These limitations are connected both to the failure to acknowledge components of knowledge used in clinical practice as well (...) as to acknowledge the physician-patient relationship's influence on clinical knowledge and on the reasoning process itself. In addition the modes of reasoning described in these studies frequently is oversimplified. In this paper three simplistic and competing models of diagnostic reasoning are analyzed and criticized, followed by an evaluation of two alternative models proposing a combined view. (shrink)

A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of what kind of kind psychiatric disorders are. Efforts have included descriptive projects, which aim to identify what psychiatrists in fact refer to when they diagnose, and prescriptive ones, which argue over that to which diagnostic categories should refer. In other words, philosophers have occupied themselves with what I call “diagnostic kinds”. However, the pride of place traditionally given to diagnostic (...) kinds in psychiatric research has recently come under attack, most notably by a recent initiative of the National Institute of Mental Health, the Research Domain Criteria Project, that seeks to exclude diagnostic categories from experimental designs and focus on other sorts of psychiatric kinds. I argue that philosophical accounts privileging diagnostic kinds must respond to this new line of criticism, and conclude that philosophers need to either counter psychiatrists’ growing suspicion about the hegemony of diagnostic categories in the clinic and the laboratory, or join in redirecting their efforts toward the development of robust accounts of other sorts of psychiatric objects and processes. (shrink)

I offer a reconstruction of contemporary medical procedures of sex assignment for infants with intersex conditions. In the perspective adopted, sex assignment to intersexed newborns can be understood as a procedure that imposes determinate sex predicates. The account describes two stages of sex assignment. At the first stage of the process, the sex predicates ‘female’, ‘male’, or ‘intersexed’ are taken to denote genital morphology. Initial genital assessment of newborns imposes clear boundaries upon the extensions of these predicates through (...) class='Hi'>diagnostic schemes of precisification. At the second stage, the sex predicates ‘female’ and ‘male’ denote sex of rearing, a therapeutic and pedagogical project aimed at producing stable and psycho-socially well-adjusted gender identity. The multi-dimensional indeterminacy of prognosticating sex of rearing at the second stage is mitigated through the prioritization of some subsets of the medical data. (shrink)

The mortality rate of patients affected with oral squamous cell carcinoma has been stable in recent decades due to several factors, especially diagnostic delay, which is often associated with a late stage diagnosis and poor prognosis. The aims of this paper were to: analyze diagnostic delay in OSCC and to discuss the various psychological factors of patients with OSCC, with particular attention to the patient’s fear of receiving news regarding their health; and the professional dynamics related to the (...) decision-making processes in cases of suspected OSCC. A preliminary review of literature focusing on OSCC diagnostic delay was performed. Seven articles were included with the diagnostic delay ranging from 45 days to approximately 6 months. Patients’ fears and, to a lesser degree, the concerns of dentists, were found to be still poorly investigated. On the basis of the authors’ professional experience, the development of oral lesions of unknown origin may generate different behaviors in the decision-making processes by patients and clinicians, and fear may play a key role in the distinct steps of this process. It is crucial to increase awareness and inform patients about the onset of OSCC, and contemporaneously encourage experimental studies on patients’ fear and professional behaviors with respect to communication regarding OSCC. (shrink)

With regard to facial emotion recognition, previous studies found that specific facial regions were attended more in order to identify certain emotions. We investigated whether a preferential search for emotion-specific diagnostic regions could contribute toward the accurate recognition of facial emotions. Twenty-three neurotypical adults performed an emotion recognition task using six basic emotions: anger, disgust, fear, happiness, sadness, and surprise. The participants’ exploration patterns for the faces were measured using the Moving Window Technique (MWT). This technique presented a small (...) window on a blurred face, and the participants explored the face stimuli through a mouse-controlled window in order to recognize the emotions on the face. Our results revealed that when the participants explored the diagnostic regions for each emotion more frequently, the correct recognition of the emotions occurred at a faster rate. To the best of our knowledge, this current study is the first to present evidence that an exploration of emotion-specific diagnostic regions can predict the reaction time of accurate emotion recognition among neurotypical adults. Such findings can be further applied in the evaluation and/or training (regarding emotion recognition functions) of both typically and atypically developing children with emotion recognition difficulties. (shrink)

Terms such as open source and various modifications including open content and more generally openness have been mobilized with increasing frequency in recent years to describe many different collaborative and not-for-profit projects, products, services, and business models. Typically associated with the computer and internet industry, openness has in recent years assumed something of the status of a nascent movement. Whatever this movement is, whatever qualities it embodies and possibilities it enables, it is still in the process of its emergence. (...) This presents particular difficulties for understanding openness insofar as emergent practices are by definition not yet stabilized. This paper is an attempt to discern the nascent forms of stability already extant in the emerging world of openness. We begin with a brief history culminating in the near future. We then summarize the limited conclusions of an initial inquiry into these emerging openness practices which we have conducted in the context of an orientation for inquiry recently put forward by Paul Rabinow and Gaymon Bennett. The bulk of the paper is devoted to elaborating openness equipment in terms of the analytic and synthetic categories made available by Rabinow and Bennett's Diagnostic of Equipmental Platforms. On the basis of this inquiry we return in the final section to reflection on the Diagnostic itself in an attempt to critically delineate its positive and negative usages for our inquiry. (shrink)

This article solves the problem of ensuring database decision-making in conditions of growing uncertainty and risks based on the results of business diagnostics is solved in this article. The main purpose of the research is to further develop the methodology of forming an analytical database for making management decisions. The following methods formed the methodological basis of the research: abstract-logical – used to generalize theoretical approaches and confirm the practical significance of solving the problem of decision-making in conditions of uncertainty (...) and risk; system analysis – when building a model of decision-making while coordinating areas and methods of business diagnostics; generalization – when drawing conclusions based on research results. The results of solving the problem of decision-making by improving the methodological approach in selecting areas and methods of business diagnostics in the conditions of growing uncertainty and risks are given in the article. The results of the research have practical value for companies that seek to reduce uncertainty and risk in the decision-making process in business management. (shrink)

The foundations of psychoanalysis in the German idealist concepts of the reflexive human self have been the subject of detailed investigations devoted to the intertwined processes of introspection,...

This article explores the profound impact of visualism and visual perception in the context of medical imaging diagnostics. It emphasizes the intricate interplay among vision, embodiment, subjectivity, language, and historicity within the realm of medical science and technology, with a specific focus on image consciousness. The study delves into the role of subjectivity in perception, facilitating the communication of opacity and historicity to the perceiving individual. Additionally, it scrutinizes the image interpretation process, drawing parallels to text interpretation and highlighting (...) the influence of personal biases and individuality in medical practice. By revisiting Husserl’s conceptualization of “image consciousness” and introducing the notion of “image theme”, the paper seeks to establish a theoretical framework for making sense of images within the context of technological interpretation. A key objective is to enhance the phenomenology of technology through a systematic analysis of medical imaging diagnosis, contributing to an expanded epistemological foundation for medical practice. The article recognizes that the construction of medical knowledge incorporates subjective elements, especially within a historical context. The interpretation of images involves both instrumental and expert interpretation, with human subjectivity playing a crucial role. The article asserts that human creativity and conscious engagement are indispensable in interpreting all medical images. (shrink)

The purpose of the study is to determine the personal results of students with disabilities and to identify the necessary conditions for effective work with this category of children in distance learning. The analysis of the results revealed the need for the use of subject-oriented technology in the educational process, which contributes to the formation of the subjective position of students, allowing for the individualization of the educational process, maximally compensating for developmental deficits caused by diseases. As a (...) result, the necessity of organizing purposeful career guidance work with disabled children and educational work with parents was revealed. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project (...) Team when making critical decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

An investigation is presented in which a computer simulation model (DIAGNOSER) is used to develop and test predictions for behavior of subjects in a task of medical diagnosis. The first experiment employed a process‐tracing methodology in order to compare hypothesis generation and evaluation behavior of DIAGNOSER with individuals at different levels of expertise (students, trainees, experts). A second experiment performed with only DIAGNOSER identified conditions under which errors in reasoning in the first experiment could be related to interpretation of (...) specific data items. Predictions derived from DIAGNOSER's performance were tested in a third experiment with a new sample of subjects. Data from the three experiments indicated that (1) form of diagnostic reasoning was similar for all subjects trained in medicine and for the simulation model, (2) substance of diagnostic reasoning employed by the simulation model was parable with that of the more expert subjects, and (3) errors in subjects' reasoning were attributable to deficiencies in disease knowledge and the interpretation of specific patient data cues predicted by the simulation model. (shrink)

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, (...) the concept of ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge. (shrink)

Partiendo de las deficiencias detectadas en la realización de la discusión diagnóstica por los estudiantes de Medicina, determinadas en un estudio previo realizado en la Facultad de Ciencias Médicas de Camagüey, se diseñó una metodología para perfeccionar la realización de la discusión diagnóstica en la carrera de Medicina, en la cual se incluyeron un sistema de tareas y las acciones que permiten alcanzar el desarrollo de las habilidades relacionadas con la misma. También se reflejaron las formas organizativas de enseñanza y (...) las actividades de educación en el trabajo en las que se deben abordar los elementos de la metodología, así como la propuesta de criterios evaluativos para estas habilidades, y otros aspectos como la ejecución y evaluación de la metodología. Se consideró que esta propuesta metodológica puede constituir una herramienta útil para los profesores en la conducción del proceso de adquisición de las habilidades de razonamiento clínico en los estudiantes. On the basis of the deficiencies identified in the realization of the diagnostic discussion by medical students, which were determined in a previous study carried out in the Faculty of medical sciences of Camagüey, a methodology was designed to improve the realization of the diagnostic discussion in Medicine degree, which included a set of tasks and actions that allow the development of skills related to it. Also, the teaching organization forms and education activities at work that must deal with methodology elements were stated, as well as the proposal of assessment criteria for these skills and other aspects like assessment and implementation of methodology. It was considered that this methodology can be used as a useful tool for teachers as guides in the process of students´ acquirement of clinical reasoning skills. (shrink)

Cognitive diagnostic models show great promise in language assessment for providing rich diagnostic information. The lack of a full understanding of second language listening subskills made model selection difficult. In search of optimal CDM that could provide a better understanding of L2 listening subskills and facilitate accurate classification, this study carried a two-layer model selection. At the test level, A-CDM, LLM, and R-RUM had an acceptable and comparable model fit, suggesting mixed inter-attribute relationships of L2 listening subskills. At (...) the item level, Mixed-CDMs were selected and confirmed the existence of mixed relationships. Mixed-CDMs had better model and person fit than G-DNIA. In addition to statistical approaches, the content analysis provided theoretical evidence to confirm and amend the item-level CDMs. It was found that semantic completeness pertaining to the attributes and item features may influence the attribute relationships. Inexplicable attribute conflicts could be a signal of suboptimal model choice. Sample size and the number of multi-attribute items should be taken into account in L2 listening cognitive diagnostic modeling studies. This study provides useful insights into the model selection and the underlying cognitive process for L2 listening tests. (shrink)

What is the value of an early diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to patients. Based on seven focusgroups with patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect (...) it to empower their capacity to care. They value it, for instance, with respect to whether it explains experienced complaints, allows to start a process of psychological acceptance and social adaptation to the expected degeneration, contributes to dealing with anxieties, informs adequately about when to start preparing for the end of life, informs the planning of a request for euthanasia, or allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered ‘harmful’ or ‘premature’ when recipients feel unable to act on that information in their care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the ‘harm’ that such diagnostic methods can bring about. (shrink)

Research Ethics, Volume 18, Issue 4, Page 265-280, October 2022. Concerns around comprehension and recall of consent information by research participants have typically been associated with low health and research literacy levels. In genomics research, this concern is heightened as the scientific and ethical complexities of genetics research, such as biobanking, genetic susceptibility, data sharing, and incidental findings may be more difficult for potential research participants to understand. However, challenges to research participants’ comprehension of consent information may be compounded by (...) factors beyond health and research literacy levels. To identify factors that may impact research participants’ understanding and recall of consent information, we designed a qualitative study to explore whether participants enrolled in a tuberculosis genetics study in Cameroon understood the objectives of the study, the risks and benefits and certain key aspects of the study such as biobanking and data sharing. The results showed that research participants had limited understanding and/or recall of the TBGEN-Africa study goals and methods. Some participants were of the opinion that TBGEN-Africa was not a genetics study because tuberculosis is not an inheritable condition. Factors that may have hindered understanding and/or recall of study information are diagnostic misconception, and information overload and situational vulnerability. There is a need for improved practices to support research participants’ understanding of consent information in genetics studies including designing the consent process in ways that minimize psychological distress and diagnostic/therapeutic misconception. (shrink)

In “Mad Narratives: Self-Constitutions Through the Diagnostic Looking Glass,” by using narrative approaches to the self, I explore how the diagnosis of mental disorder shapes personal identities and influences flourishing. My particular focus is the diagnosis grounded on the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM). I develop two connected accounts pertaining to the self and mental disorder. I use the memoirs and personal stories written by the subjects with a DSM diagnosis as illustrations (...) to bolster my claims. First, expanding on the narrative approaches to the self, I explain how narratives about a subject shape her self-constitution. I elucidate how this process is generated by drawing on research in developmental psychology, cognitive science, and social psychology. Next, using this account as a springboard, I argue that the DSM diagnosis of mental disorder serves as a source of narrative, entering into the patients’ autobiographical and social narratives. This plays an important role in the diagnosed subjects’ self-understanding, self-constitution and flourishing. In this vein, how mental disorders are classified is not only a theoretical question about accurately taxonomizing the various experiences related to mental distress but also an ethical question about which ways of talking about mental disorders will allow subjects to respond effectively to their psychological distress, to flourish and to live autonomous and fulfilling lives. Finally, I suggest that the DSM-based narratives wield a double-edged sword when it comes to the subject’s flourishing: On the one hand, there are problems with some DSM-based narratives that stem from the DSM diagnostic schema and the culture of DSM diagnoses. These problems render these DSM-based narratives unbeneficial for flourishing as they constrain the range of adoptive social, cognitive and emotional responses the subjects can give to their mental disorders. On the other hand, there are grounds to believe that some DSM-based narratives help subjects to flourish. For instance, they provide certainty to subjects' otherwise puzzling symptoms and help them reach out to others with similar experiences. Understanding how the DSM-based narratives can both benefit and harm will help us address problems with psychiatric diagnoses and the dissemination of knowledge about mental disorders in popular culture. The project aims to convince both philosophers and psychiatrists that no plausible theory of the self can be developed without attending to the topic of mental disorder and that no theory of mental disorder can be complete without devising the tools provided by the philosophical approaches to the self as well as developmental and social psychology. It also calls for methodological alterations in mental health ethics research, arguing that a careful scrutiny of mental disorder memoirs can advance the ethical underpinnings to the practice of psychiatry. (shrink)

The profession of medicine is predicated upon an ethical mandate: first do no harm. However, critics charge that the medical profession’s culture and its public health mission are being undermined by the pharmaceutical industry’s wide-ranging influence. In this article, we analyze how drug firms influence psychiatric taxonomy and treatment guidelines such that these resources may serve commercial rather than public health interests. Moving beyond a conflict-ofinterest model, we use the conceptual and normative framework of institutional corruption to examine how organized (...) psychiatry’s dependence on drug firms has distorted science. We suggest that academic-industry relationships have led to the corruption of the evidence base upon which accurate diagnosis and sound treatment depend. We describe the current dependency corruption and argue that transparency alone is not a solution — and sometimes even produces iatrogenic effects. Furthermore, we argue that the corruption of the evidence base for diagnostic and practice guidelines renders obsolete the traditional informed consent process, and we offer suggestions for reforming this process. (shrink)

The possibility that industry is exerting an undue influence on the culture of medicine has profound implications for the profession's public health mission. Policy analysts, investigative journalists, researchers, and clinicians have questioned whether academic-industry relationships have had a corrupting effect on evidence-based medicine. Psychiatry has been at the heart of this epistemic and ethical crisis in medicine. This article examines how commercial entities, such as pharmaceutical companies, influence psychiatric taxonomy and treatment guidelines. Using the conceptual framework of institutional corruption, we (...) show that organized psychiatry's dependence on drug firms has led to a distortion of science. We describe the current dependency corruption and argue that transparency alone is not a solution. We conclude by taking the position that the corruption of the evidence base in diagnostic and practice guidelines has compromised the informed consent process, and we suggest strategies to address this problem. (shrink)

In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of (...) reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines. (shrink)

The claim that visually masked, unidentifiable words are analyzed at the level of whole word meaning has been challenged by recent findings indicating that instead, analysis occurs mainly at the subword level. The present experiments examined possible limits on subword analysis. Experiment 1 obtained semantic priming from pleasant- and unpleasant-meaning subliminal words in which no individual letter contained diagnostic information about a word’s evaluative valence; thus analysis must operate on information more complex than that contained in individual letters. Experiments (...) 2 and 3 showed that analysis must operate on information more complex than that represented by individual bigrams or trigrams . These findings suggest that while subliminal priming is driven by subword analysis, the effective units of analysis are distributed widely across at least short words. (shrink)

This article investigates the origins of the experiences involved in the diagnostics (detection and normative evaluation) of biological entities in image-based medical praxis. Our specific research aim presupposes a vast discussion regarding the origins of knowledge in general, but is narrowed down to the alternatives of anthropomorphism and biomorphism. Accordingly, in the subsequent chapters we will make an attempt to investigate and illustrate what holds the diagnostic experiential situation together—biological regularities, manifestation via movement, conscious synthesis, causal categories, or something (...) else. We argue that as long as knowledge originates out of practices, a promising way forward is to oscillate between the prominent although controversial ideas of the history of philosophy and observations of concrete human practices, such as, in our chosen example, image-based medical diagnostics of biological pathologies. Although a number of thinkers are involved in the discussion, Aristotle and Husserl are most important here as the representatives of historical paradigms on the matter. The body in this research was not taken solely as the physical entity (Körper) but rather as a transcendental, constitutive structure where diagnostic and biological processes synchronize in teleological movement (Leib). However, philosophical speculations are illustrated by actual radiograms, the interpretation of which brings us back to the aforementioned question of primacy regarding cognition. (shrink)

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their (...) actual usage and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

In this paper, we first classify different types of second opinions and evaluate the ethical and epistemological implications of providing those in a clinical context. Second, we discuss the issue of how artificial intelligent could replace the human cognitive labour of providing such second opinion and find that several AI reach the levels of accuracy and efficiency needed to clarify their use an urgent ethical issue. Third, we outline the normative conditions of how AI may be used as second opinion (...) in clinical processes, weighing the benefits of its efficiency against concerns of responsibility attribution. Fourth, we provide a ‘rule of disagreement’ that fulfils these conditions while retaining some of the benefits of expanding the use of AI-based decision support systems in clinical contexts. This is because the rule of disagreement proposes to use AI as much as possible, but retain the ability to use human second opinions to resolve disagreements between AI and physician-in-charge. Fifth, we discuss some counterarguments. (shrink)

The paper deals with the introduction of nanotechnology in biochips. Based on interviews and theoretical reflections, it explores blind spots left by technology assessment and ethical investigations. These have focused on possible consequences of increased diffusability of a diagnostic device, neglecting both the context of research as well as increased accuracy, despite it being a more essential feature of nanobiochip projects. Also, rather than one of many parallel aspects in innovation processes, ethics is considered here as a ubiquitous system (...) of choices between sometimes antagonistic values. Thus, the paper investigates what is at stake when accuracy is balanced with other practical values in different contexts. Dramatic nanotechnological increase of accuracy in biochips can raise ethical issues, since it is at odds with other values such as diffusability and reliability. But those issues will not be as revolutionary as is often claimed: neither in diagnostics, because accuracy of measurements is not accuracy of diagnostics; nor in research, because a boost in measurement accuracy is not sufficient to overcome significance-chasing malpractices. The conclusion extends to methodological recommendations. (shrink)

Frailty has recently become a medical category with physical symptoms that define its diagnosis. This paper uses the resources of an ethics of care to analyze the relationship between frailty and fragility or vulnerability, the positives of frailty becoming a diagnostic category, and some problematic aspects of the same process.

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

Multi-level teaching has been proven to be more effective than a one-size-fits-all learning approach. This study aimed to develop and implement a multi-level remedial teaching scheme in various high school classes containing students of a wide range of learning levels and to determine its effect of their learning. The deterministic inputs noisy and gate model of cognitive diagnosis theory was used to classify students at multiple levels according to their knowledge and desired learning outcomes. A total of 680 senior high (...) school students from central provinces in China participated in the initial cognitive diagnostic test, and 1,615 high school sophomores from seven high schools in China participated in a formal cognitive diagnosis test. Thirty-six high school students from Southwestern China participated in the think-aloud protocols, and 258 seniors from three high schools in southwest China participated in the remedial teaching experiment. Through an analysis of students’ think-aloud protocols, cognitive errors of students at all levels were determined, and multi-level remedial teaching programs were designed to address these common cognitive errors. The remedial teaching programs were then implemented in three schools and compared with a control group. The results indicated that the students in the experimental group showed a more significant improvement. In this study, the steps of designing multi-level remedial teaching include assessment, classification, and preparing a teaching scheme, which are feasible and can have remarkable teaching effects. This process can be used for reference by teachers of various subjects. (shrink)

This book is a joint effort of like-minded researchers to define the concept of process within a psychological setting. Although minor differences exist as regards choice of background theory, their common focus is on personality in a broad psychodynamic context. Their definition of personality rests on a series of test instruments that have been validated during decades of thorough and vigorous empirical work. These were originally designed to open up micro-processes underlying the adaptation to or construction of reality, and (...) have subsequently proven diagnostically efficient. Coming from both sides of the Atlantic, the contributors have their background in psychological as well as medical institutions. The contributions in the book are examples of a vital source sustaining our efforts to get a more profound understanding of the vicissitudes of the human mind. (shrink)

The article is based on research conducted at the actual radiology department. It presents a range of descriptions and analyses of concrete operations performed by radiologists during their daily professional routine. After careful ethnographic observations, phenomenological analysis is employed with a view to examining the enactive cognition in the radiologist’s “life-world”. The paper uses both ethnography and phenomenology in order to reveal the essential regularities and sedimentations of everyday radiological processes, and the “everyday background” of certain scientific-cognitive operations. The method (...) of research includes “enactive proofs”— observations and analysis of the externalization of a radiologist’s professional memory through the enaction of medical imaging and imageconsciousness. The findings of this research have much to offer to both philosophy and radiological praxis. While the observations strongly support the development of enactive phenomenology, critique of representationalism, primacy of inference in cognition, and shared intentions, they also provide insight into concrete operations in coping with radiology’s paraphernalia, habituality, the origin of mistakes, multilayered communication, and improving professional praxis. (shrink)

The following topics are considered: - 1) Computer-based medical consultation: good doctors have the capacity to make right guesses. - 2) Elementary diagnostic logic: illness as a boolean combination of signs or symptoms, diagnosis as a deductive process. - 3) Clinical decision under uncertainty: partial and/or elusive evidence, overlapping types. - 4) Local heuristic strategies: (1) statistical methods, (2) probabilistic (bayesian) methods, (3) fuzzy methods and Mycin-type expert systems. - 5) General heuristic strategies: representing medical knowledge (rules, nets, (...) frames), simulating expert behavior. - 6) Diagnostic inference and pattern recognition: natural species vs. expert judgement. (shrink)

According to the shared signal hypothesis the impact of facial expressions on emotion processing partially depends on whether the gaze is directed toward or away from the observer. In autism spectrum disorder several aspects of face processing have been found to be atypical, including attention to eye gaze and the identification of emotional expressions. However, there is little research on how gaze direction affects emotional expression processing in typically developing individuals and in those with ASD. This question is investigated here (...) in two multimodal experiments. Experiment 1 required processing eye gaze direction while faces differed in emotional expression. Forty-seven children participated. Their Autism Diagnostic Observation Schedule scores ranged from 0 to 6 in the experiment. Event-related potentials were sensitive to gaze direction and emotion, but emotion processing did not depend on gaze direction. However, for angry faces the gaze direction effect on the N170 amplitude, as typically observed in TD individuals, diminished with increasing ADOS score. For neutral expressions this correlation was not significant. Experiment 2 required explicit emotion classifications in a facial emotion composite task while eye gaze was manipulated incidentally. A group of 22 children with ASD was compared to a propensity score-matched group of TD children. The same comparison was carried out for a subgroup of nine children with ASD who were less trained in social cognition, according to clinician’s report. The ASD group performed overall worse in emotion recognition than the TD group, independently of emotion or gaze direction. However, for disgust expressions, eye tracking data revealed that TD children fixated relatively longer on the eyes of the stimulus face with a direct gaze as compared with averted gaze. In children with ASD we observed no such modulation of fixation behavior as a function of gaze direction. Overall, the present findings from ERPs and eye tracking confirm the hypothesis of an impaired sensitivity to gaze direction in children with ASD or elevated autistic traits, at least for specific emotions. Therefore, we conclude that multimodal investigations of the interaction between emotional processing and stimulus gaze direction are promising to understand the characteristics of individuals differing along the autism trait dimension. (shrink)

This paper approaches the interaction of a health professional with an AI system for diagnostic purposes as a hybrid decision making process and conceptualizes epistemo-ethical constraints on this process. We argue for the importance of the understanding of the underlying machine epistemology in order to raise awareness of and facilitate realistic expectations from AI as a decision support system, both among healthcare professionals and the potential benefiters. Understanding the epistemic abilities and limitations of such systems is essential (...) if we are to integrate AI into the decision making processes in a way that takes into account its applicability boundaries. This will help to mitigate potential harm due to misjudgments and, as a result, to raise the trust—understood here as a belief in reliability of—in the AI system. We aim at a minimal requirement for AI meta-explanation which should distinguish machine epistemic processes from similar processes in human epistemology in order to avoid confusion and error in judgment and application. An informed approach to the integration of AI systems into the decision making for diagnostic purposes is crucial given its high impact on health and well-being of patients. (shrink)

Background While integrating genomic sequencing into clinical care carries clear medical benefits, it also raises difficult ethical questions. Compared to traditional sequencing technologies, genomic sequencing and analysis is more likely to identify unsolicited findings (UF) and variants that cannot be classified as benign or disease-causing (variants of uncertain significance; VUS). UF and VUS pose new challenges for genetic health professionals (GHPs) who are obtaining informed consent for genomic sequencing from patients.Methods We conducted semi-structured interviews with 31 GHPs across Europe, Australia (...) and Canada to identify some of these challenges.Results Our results show that GHPs find it difficult to prepare patients to receive results because a vast amount of information is required to fully inform patients about VUS and UF. GHPs also struggle to engage patients – many of whom may be focused on ending their ‘diagnostic odyssey’ – in the informed consent process in a meaningful way. Thus, some questioned how ‘informed’ patients actually are when they agree to undergo clinical genomic sequencing.Conclusions These findings suggest a tension remains between sufficient information provision at the risk of overwhelming the patient and imparting less information at the risk of uninformed decision-making. We suggest that a shift away from ‘fully informed consent’ toward an approach aimed at realizing, as far as possible, the underlying goals that informed consent is meant to promote. (shrink)