Philosophy of Medicine has for a long time been preoccupied with analyzing the concepts of health, disease and illness. Relatively speaking, the concept of medicine itself has received very little attention. This paper is a contribution to the relatively neglected debate about the nature of medicine. Building on the work of Alex Broadbent (Broadbent, 2018a, b), Chadwin Harris (Harris, 2018) and Thaddeus Metz (Metz, 2018), in this paper I question the persuasiveness of Broadbent’s account of the “core (...) business” of medicine, The Inquiry Thesis, and propose an alternative: a revised version of The Curative Thesis, which I coin The Best Available Intervention Thesis. Crudely, this suggests that Medicine is the sustained and organised effort to determine and prescribe the best available treatment (curative or preventative) for patients. (shrink)

In this paper I untangle a recent debate in the philosophy of epidemiology, focusing in particular on the Potential Outcomes Approach to causation. As the POA strategy includes the quantification of ‘contrary-to-fact’ outcomes, it is unsurprising that it has been likened to the counterfactual analysis of causation briefly proposed by David Hume, and later developed by David Lewis. However, I contend that this has led to much confusion. Miguel Hernan and Sarah Taubman have recently argued that meaningful causal inferences cannot (...) be drawn from obesity. This paper prompted Alex Broadbent to criticise the POA conception of causation, accusing two of the four theses its proponents are committed to, of circularity and falsity. Here I scrutinise Broadbent’s claims, and suggest that a Popperian approach to causal inference in epidemiology diffuses both of his objections. However, I move on to argue that the POA’s commitment to granting only manipulable conditions causal-status, renders the position implausible as a conceptual analysis of causation. That said, I conclude that the strategy the POA employs is an effective tool for effect-measurement in intervention-cases; if it is a conceptual analysis of causation at all, it must be restricted to the causal analysis of manipulable conditions. The POA’s failure to successfully demarcate causal from non-causal conditions simpliciter should therefore not be viewed as a serious threat. (shrink)

In this series of lectures, a distinguished group of international contributors from a variety of disciplines debate the current position of the recent achievements in engineering and computer science. (Technology & Industrial).

Causation The question, “What is causation?” may sound like a trivial question—it is as sure as common knowledge can ever be that some things cause another; that there are causes and they necessitate certain effects. We say that we know that what caused the president’s death was an assassin’s shot. But when asked why, we … Continue reading Causation →.

Nineteenth-century medical advances were entwined with a conceptual innovation: the idea that many cases of disease which were previously thought to have diverse causes could be explained by the action of a single kind of cause, for example a certain bacterial or parasitic infestation. The focus of modern epidemiology, however, is on chronic non-communicable diseases, which frequently do not seem to be attributable to any single causal factor. This paper is an effort to resolve the resulting tension. The paper criticises (...) the monocausal model of disease, so successful in the nineteenth century. It also argues that a multifactorial model of disease can only be satisfactory if it amounts to more than a mere rejection of the monocausal model. A third alternative, the contrastive model, is proposed and defended on the grounds that it links the notions of disease and of general explanation, while avoiding the philosophical naiveties and practical difficulties of the monocausal model. (shrink)

In this series of lectures, a distinguished group of international contributors from a variety of disciplines debate the current position of the recent achievements in engineering and computer science. (Technology & Industrial).

This paper takes issue with those commentators of Heidegger's philosophy whose point of entry into his thinking is the inherited prejudices of others. It demonstrates that if prior judgments are suspended, so that Heidegger's texts are permitted to speak for themselves, the truth of his `position', more a wege than a static motionless point, gradually and inexorably begins to emerge. I take Pope Benedict's first encyclical, Deus Caritas Est, to draw the theological contours of a truly post-modern ethic. I then (...) hold up Heidegger's philosophy, as this is characterized principally though not exclusively in his lecture Der Satz Der Identität, to consider possible symmetries. Finally I offer an answer to the question: does Heidegger's thought have ethical consequences? (shrink)

Philosophy of Medicine provides a fresh and comprehensive treatment of the topic. It offers a novel theory of the nature of medicine, and proposes a new attitude to medicine, aimed at improving the quality of debates between medical traditions and facilitating medicine's decolonization.

This paper puts forward a general framework for thought about human information processing. It is intended to avoid some of the problems of pipeline or stage models of function. At the same time it avoids the snare of supposing a welter of indefinitely many separate processes. The approach is not particularly original, but rather represents the common elements or presuppositions in a number of modern theories. These presuppositions are not usually explicit, however, and making them so reduces the danger of (...) slipping back into earlier modes of thought.The key point is to distinguish between persisting representations and the processes that translate one representation into another. Various classes or groups of persisting representations can be distinguished by the experimental treatments that interfere with them. In particular, there now seem to be several kinds of short-term or temporary storage, different from each other as well as from longterm memory; the translating processes also have several different modes or kinds. A particularly important aspect of the current position is that a model of this general type no longer requires some external agent to direct and control long sequences of behaviour. (shrink)

This paper argues that machine learning and epidemiology are on collision course over causation. The discipline of epidemiology lays great emphasis on causation, while ML research does not. Some epidemiologists have proposed imposing what amounts to a causal constraint on ML in epidemiology, requiring it either to engage in causal inference or restrict itself to mere projection. We whittle down the issues to the question of whether causal knowledge is necessary for underwriting predictions about the outcomes of public health interventions. (...) While there is great plausibility to the idea that it is, conviction that something is impossible does not by itself motivate a constraint to forbid trying. We disambiguate the possible motivations for such a constraint into definitional, metaphysical, epistemological, and pragmatic considerations and argue that “Proceed with caution” is the outcome of each. We then argue that there are positive reasons to proceed, albeit cautiously. Causal inference enforces existing classification schema prior to the testing of associational claims, but associations and classification schema are more plausibly discovered in a back-and-forth process of gaining reflective equilibrium. ML instantiates this kind of process, we argue, and thus offers the welcome prospect of uncovering meaningful new concepts in epidemiology and public health—provided it is not causally constrained. (shrink)

This chapter explores the idea that causal inference is warranted if and only if the mechanism underlying the inferred causal association is identified. This mechanistic stance is discernible in the epidemiological literature, and in the strategies adopted by epidemiologists seeking to establish causal hypotheses. But the exact opposite methodology is also discernible, the black box stance, which asserts that epidemiologists can and should make causal inferences on the basis of their evidence, without worrying about the mechanisms that might underlie their (...) hypotheses. I argue that the mechanistic stance is indeed a bad methodology for causal inference. However, I detach and defend a mechanistic interpretation of causal generalisations in epidemiology as existence claims about underlying mechanisms. (shrink)

In the literature on health, naturalism and normativism are typically characterized as espousing and rejecting, respectively, the view that health is objective and value-free. This article points out that there are two distinct dimensions of disagreement, regarding objectivity and value-ladenness, and thus arranges naturalism and normativism as diagonal opposites on a two-by-two matrix of possible positions. One of the remaining quadrants is occupied by value-dependent realism, holding that health facts are value-laden and objective. The remaining quadrant, which holds that they (...) are non-objective but value-free, is unexplored. The article endorses a view in the latter quadrant, namely, the view that health is a secondary property. The article argues that a secondary property framework provides the resources to respond to the deepest objections to a broadly Boorsean account of natural function, and so preserves the spirit, though not the letter, of that account. Treating health as a secondary property permits a naturalistic explanation—specifically, an evolutionary explanation—of the health concept, in terms of the assistance such a concept might have provided to the survival and reproduction of those organisms that had it. This provides the explanation, missing from Boorse's account, for the fact that function is determined with reference to the contribution to the goals of survival and reproduction, relative to the age of the sex of the species, rather than some other equally natural goals or reference classes. _1_ Introduction _2_ Two Ways to Disagree about Health _3_ Secondary Properties _4_ Health as a Secondary Property _5_ Conclusion. (shrink)

When is a cause of a cause of an effect also a cause of that effect? The right answer is either Sometimes or Always . In favour of Always , transitivity is considered by some to be necessary for distinguishing causes from redundant non-causal events. Moreover transitivity may be motivated by an interest in an unselective notion of causation, untroubled by principles of invidious discrimination. And causal relations appear to add up like transitive relations, so that the obtaining of the (...) overarching relation is not independent of the obtaining of the intermediaries. On the other hand, in favour of Sometimes , often we seem not to treat events that are very spatiotemporally remote from an effect as its causes, even when connected to the effect in question by a chain of counterfactual or chance-raising dependence. Moreover cases of double prevention provide counterexamples to causal transitivity even over short chains. According to the argument of this paper, causation is non-transitive. Transitizing causation provides no viable account of causal redundancy. An unselective approach to causation may motivate resisting the distance counterexamples to transitivity, but it does not help with double prevention, and even makes it more intractable. The strongest point in favour of transitivity is the adding up of causal relations, and this is the point that extant non-transitizing analyses have not adequately addressed. I propose a necessary condition on causation that explains the adding up phenomenon. In doing so it also provides a unifying explanation of distance and double prevention counterexamples to transitivity. (shrink)

According to the evolutionary sceptic, the fact that our cognitive faculties evolved radically undermines their reliability. A number of evolutionary epistemologists have sought to refute this kind of scepticism. This paper accepts the success of these attempts, yet argues that refuting the evolutionary sceptic is not enough to put any particular domain of beliefs – notably scientific beliefs, which include belief in Darwinian evolution – on a firm footing. The paper thus sets out to contribute to this positive justificatory project, (...) underdeveloped in the literature. In contrast to a ‘wholesale’ approach, attempting to secure justification for all of our beliefs on the grounds that our belief-forming mechanisms evolved to track truth, we propose a ‘piecemeal’ approach of assessing the reliability of particular belief-forming mechanisms in particular domains. This stands in contrast to the more familiar attempt to transfer warrant obtained for one domain to another by showing how one is somehow an extension of the other. We offer a naturalist reply to the charge of circularity by appealing to reliabilist work on the problem of induction, notably Peter Lipton's distinction between self-certifying and non-self-certifying inductive arguments. We show how, for scientific beliefs, a non-self-certifying argument might be made for the reliability of our cognitive faculties in that domain. We call this strategy Humean Bootstrapping. (shrink)

The counterfactual analysis of causation has focused on one particular counterfactual conditional, taking as its starting-point the suggestion that C causes E iff (C E). In this paper, some consequences are explored of reversing this counterfactual, and developing an account starting with the idea that C causes E iff (E C). This suggestion is discussed in relation to the problem of pre-emption. It is found that the 'reversed' counterfactual analysis can handle even the most difficult cases of pre-emption with only (...) minimal complications. The paper closes with a discussion of the wider philosophical implications of developing a reversed counterfactual analysis, especially concerning the differentiation of causes from causal conditions, causation by absences, and the extent to which causes suffice for their effects. (shrink)

The Covid-19 pandemic was a world event on our intellectual doorstep. What were our duties to respond, and how well did we respond? We published papers, but we did not engage extensively or influentially in public debate. Perhaps we felt we were not experts. Yet in a health crisis, philosophers of medicine can offer not only “conceptual clarification,” but also domain-specific knowledge concerning structural properties of relevant sciences and their social-political uses. I set out three conditions for the kind of (...) contribution I felt was lacking: public, critical, and timely. And I call for us to do more of it. (shrink)

This paper takes it as a premise that a distinction between matters of fact and of law is important in the causal inquiry. But it argues that separating factual and legal causation as different elements of liability is not the best way to implement the fact/law distinction. What counts as a cause-in-fact is partly a legal question; and certain liability-limiting doctrines under the umbrella of “legal causation” depend on the application of factual-causal concepts. The contrastive account of factual causation proposed (...) in this paper improves matters. This account more clearly distinguishes matters of fact from matters of law within the cause-in-fact inquiry. It also extends the scope of cause-in-fact to answer some questions currently answered by certain doctrines of legal causation—doctrines that, it is argued, are more naturally seen as applications of our ordinary causal concept than as noncausal liability-limiting devices. (shrink)

What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this “curative thesis” is not satisfactory, even when “cure” is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Moreover, the efficacy of medicine (...) for improving population health has been famously doubted by historians and epidemiologists. The curative thesis demands that we have mostly been stupid, duped, or staggeringly hopeful, given that medicine has not until recently offered more than a handful of effective cures. I suggest, in this article, that the core medical competence is neither to cure, nor to prevent, disease, but to understand and to predict it. I argue that this approach does a better job than the curative thesis at explaining why not all medicine is concerned with curative efforts and that it enjoys historical support from the ancient entanglement of prophecy and medicine and from the fact that medicine thrived for centuries with almost no effective cures and continues to thrive today in various forms that are mostly without curative efficacy. I suggest that this approach grounds a fairer approach to alternative, traditional, and other medical practices, as well as some fresh lessons for the development of mainstream medicine. (shrink)

Commonly we distinguish the strike of a match, as a cause of the match lighting, from the presence of oxygen, as a mere condition. In this paper I propose an account of this phenomenon, which I call causal selection. I suggest some reasons for taking causal selection seriously, and indicate some shortcomings of the popular contrastive approach. Chief among these is the lack of an account of contrast choice. I propose that contrast choice is often just the counterfactual scenario in (...) which the effect does not occur: I suggest that if c causes e , then if e hadn't occurred, c wouldn't have occurred. I argue that this is a necessary condition on causation which causes meet but mere conditions fail. (shrink)

This paper seeks to determine the significance, if any, of epidemiological evidence to prove the specific causation element of liability in negligence or other relevant torts—in particular, what importance can be attached to a relative risk > 2, where that figure represents a sound causal inference at the general level. The paper discusses increased risk approaches to epidemiological evidence and concludes that they are a last resort. The paper also criticizes the proposal that the probability of causation can be estimated (...) with reference to the RR, such that RR > 2 is necessary and sufficient for causation. It is argued, following arguments by Sander Greenland and others, that RR > 2 is not necessary for proof of specific causation, except under restrictive biological assumptions that are not known to be satisfied for any important disease, and therefore must never be required. However, the paper argues that in some circumstances RR > 2 can be sufficient to prove causation at law. This position is defended against the widely held judicial and academic view that epidemiological evidence must be accompanied by something else, particular to the case at hand, if it is to have probative force for specific causation. It is argued that far from being epistemically irrelevant, to achieve correct and just outcomes it is in fact mandatory to take epidemiological evidence into account in deciding specific causation. Failing to consider such evidence when it is available leads to error and injustice. The conclusion is that in certain circumstances epidemiological evidence of RR > 2 is not necessary to prove specific causation but that it is sufficient. This “sufficiency” is confined to circumstances where there is no other evidence, as a way of getting clear on what the epidemiological evidence says. Once we have worked out what it says, this must be weighed against the other relevant evidence, if there is any. (shrink)

Crossing the road within the traffic system is an example of an action human agents perform successfully day-to-day in complex systems. How do they perform such successful actions given that the behaviour of complex systems is often difficult to predict? The contemporary literature contains two contrasting approaches to the epistemology of complex systems: an analytic and a post-modern approach. We argue that neither approach adequately accounts for how successful action is possible in complex systems. Agents regularly perform successful actions without (...) obeying (explicit or implicit) algorithmic rules (as the analytic approach suggests) and without an existential leap to action (as the post-modern approach suggests). We offer an alternative: A common-sense pragmatist epistemology, one that focuses on the kind of actions making up most agents’ successful moment-to-moment actions in complex systems. Successful actions obtain when agents apply ceteris paribus rules-of-thumb during predictive and decisional practices while achieving some desired goal. (shrink)

When graduate students start their studies, they usually have sound knowledge of some areas of philosophy, but the overall map of their knowledge is often patchy and disjointed. There are a number of topics that any contemporary philosopher working in any part of the analytic tradition needs to grasp, and to grasp as a coherent whole rather than a rag-bag of interesting but isolated discussions. This book answers this need, by providing a overview of core topics in metaphysics and epistemology (...) that is at once accessible and nuanced. Ten core topics are explained, and their relation to each other is clearly set out. The book emphasizes the utility of the concepts and distinctions it covers for philosophy as a whole, not just for specialist discussions in metaphysics or epistemology. The text is highly readable and may be used as the basis of a course on these topics. Recommendations for reading are included at the end of each chapter, divided into essential and further readings. The text is also suitable for people approaching philosophy from other disciplines, as an accessible primer to the central topics, concepts and distinctions that are needed to engage meaningfully in contemporary philosophical debate. (shrink)

This paper considers an important recent contribution by Miguel Hernán to the ongoing debate about causal inference in epidemiology. Hernán rejects the idea that there is an in-principle epistemic distinction between the results of randomized controlled trials and observational studies: both produce associations which we may be more or less confident interpreting as causal. However, Hernán maintains that trials have a semantic advantage. Observational studies that seek to estimate causal effect risk issuing meaningless statements instead. The POA proposes a solution (...) to this problem: improved restrictions on the meaningful use of causal language, in particular “causal effect”. This paper argues that new restrictions in fact fail their own standards of meaningfulness. The paper portrays the desire for a restrictive definition of causal language as positivistic, and argues that contemporary epidemiology should be more realistic in its approach to causation. In a realist context, restrictions on meaningfulness based on precision of definition are neither helpful nor necessary. Hernán’s favoured approach to causal language is saved from meaninglessness, along with the approaches he rejects. (shrink)

ABSTRACTIt is proposed that experts are able to integrate prior contextual knowledge with emergent visual information to make complex predictive judgments about the world around them, often under heightened levels of uncertainty and extreme time constraints. However, limited knowledge exists about the impact of anxiety on the use of such contextual priors when forming our decisions. We provide a novel insight into the combined impact of contextual priors and anxiety on anticipation in soccer. Altogether, 12 expert soccer players were required (...) to predict the actions of an oncoming opponent while viewing life-sized video simulations of 2-versus-2 defensive scenarios. Performance effectiveness and processing efficiency were measured under four conditions: no contextual priors about the action tendencies of the opponent and low anxiety ; no CP and high anxiety ; CP and LA; CP and HA. The provision of contextual priors did not affect processing efficiency, but it improved performance effectiveness... (shrink)