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)

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)

We are pleased to once again present to the readers of Theoretical Medicine and Bioethics papers from the Philosophy of Medicine Roundtable. Previous issues have followed the 3rd and 4th Roundtables, and the current issue presents a selection from the more than 20 papers presented at the 5th Philosophy of Medicine Roundtable, which took place in New York, at Columbia University, in November 2013. Like its predecessors, held in Birmingham, AL, Rotterdam, and San Sebastian, this Roundtable attracted speakers from around (...) the world. It also featured keynote presentations from Rita Charon of Columbia University and Ross Upshur of the University of Toronto.It may seem somewhat odd to feature a special issue on philosophy of medicine in a journal that effectively has philosophy of medicine in its title. However, a review of the contents of this journal and similar ones, such as the Journal of Medicine and Philosophy, will quickly reveal such an issue’s purpose. The dominant content of these j .. (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)

In this article I seek to say what it is for something to count as a neglected disease. I argue that neglect should be defined in terms of efforts at prevention, mitigation and cure, and not solely in terms of research dollars per disability-adjusted life-year. I further argue that the trend towards multifactorialism and risk factor thinking in modern epidemiology has lent credibility to the erroneous view that the primary problem with neglected diseases is a lack of research. A more (...) restrictive contrastive model of disease is endorsed as better suited to the definition of neglected disease. (shrink)

Societal collapse has been a perennial concern of humanity, at least since the early Greeks. Recent publication of Jared Diamond's Collapse: How Societies Choose to Fail or Succeed and Ervin Laszlo's The Chaos Window: The World at the Crossroads renew this concern. Despite the urgency in these and many similar calls to action, no consensus theory and practice of evolutionary civilization exists. This article calls for collaborative action by the evolutionary systems community and related disciplines to provide insight into what (...) has been dubbed "the most important question in the world today" (Smith, 2005, p. 436). (shrink)

Alex Broadbent’s Philosophy of Epidemiology is the latest volume in Palgrave Macmillan’s New Directions in the Philosophy of Science series. Other monographs in the series focus on mathematics, biology, astronomy, et al.—the usual topics of discourse when philosophers engage science. The present volume is a welcome addition not just to the series but also for the field of epidemiology. As Broadbent notes, “Although a few philosophers have studied epidemiology, there have been no philosophical studies of epidemiology” . There (...) is one now.As noted in the book’s foreword, the core theme of Philosophy of Epidemiology “has to do with the nature and role of explanation and prediction in epidemiological analyses” . These are practical matters which are familiar to epidemiologists, but being largely mechanical in nature, “this explains why philosophers of science have neglected epidemiology” .Broadbent is a young philosopher, trained at Cam .. (shrink)

The case of Semmelweis has been well known since Hempel. More recently, it has been revived by Peter Lipton, Donald Gillies, Alexander Bird, Alex Broadbent, and Raphael Scholl. While these accounts differ on what exactly the case of Semmelweis shows, they all agree that Semmelweis was an excellent reasoner. This widespread agreement has also given rise to a puzzle: why Semmelweis’s views were rejected for so long. I aim to dissolve both this puzzle and the standard view of Semmelweis (...) by showing that, contrary to prevailing opinion, Semmelweis was not the excellent reasoner he has been assumed to be. (shrink)

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists have gradually acknowledged that (...) much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects. (shrink)

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)

Our visual experience of the world is one of diverse objects and events, each with particular colors, shapes, and motions. This experience is so coherent, so immediate, and so effortless that it seems to result from a single system that lets us experience everything in our field of view. But however appealing, this belief is mistaken: there are severe limits on what can be visually experienced. -/- For example, in a display for air-traffic control it is important to track all (...) moving items. For a single item, this can be done without problem. Three or four can also be tracked, although some degree of effort may be needed. As the number is increased further, accurate tracking becomes more and more difficult—and eventually, impossible. Performance is evidently affected by a factor within the observer which enables certain kinds of perception to occur, but is limited in some way. This factor is generally referred to as attention. -/- At various times, attention has been associated with clarity of perception, intensity of perception, consciousness, selection, or the allocation of a limited “resource” enabling various operations (see Hatfield, 1998). During the past several decades, considerable progress has been achieved by focusing on the idea of selection (Broadbent, 1982). In particular, attention can be productively viewed as contingently selective processing. This can be embodied in various ways by various processes—there need not be a single quantity identified with all forms of attention, or a single site where it operates (Allport, 1993; Tsotsos, 2011). Although “paying attention” is often considered to be a unitary operation, it may simply refer to the control of one or more selective processes, ideally in a co-ordinated way. While this view has some cost in terms of conceptual simplicity, it can help make sense of a large set of phenomena. -/- This article surveys several of the major issues in our understanding of attention and how it relates to perception. It focuses on vision, since many—if not all—considerations are similar for all sensory modalities, and the level of understanding achieved in this domain is currently the most advanced. (shrink)

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that medicine is (...) (at least in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

This paper examines racial discrimination and algorithmic bias in predictive policing algorithms (PPAs), an emerging technology designed to predict threats and suggest solutions in law enforcement. We first describe what discrimination is in a case study of Chicago’s PPA. We then explain their causes with Broadbent’s contrastive model of causation and causal diagrams. Based on the cognitive science literature, we also explain why fairness is not an objective truth discoverable in laboratories but has context-sensitive social meanings that need to (...) be negotiated through democratic processes. With the above analysis, we next predict why some recommendations given in the bias reduction literature are not as effective as expected. Unlike the cliché highlighting equal participation for all stakeholders in predictive policing, we emphasize power structures to avoid hermeneutical lacunae. Finally, we aim to control PPA discrimination by proposing a governance solution—a framework of a social safety net. (shrink)

Blind tasting — tasting without knowing the wine’s producer, origin, or other details obtainable from the wine’s label— has become something of a fetish in the wine world. We are told, repeatedly and insistently, that blind tasting is the best, most neutral, least biased, and most honest evaluative procedure, and one that should be employed to the exclusion of non-blind/sighted tasting (which, in turn, is typically disparaged as confused, biased, or dishonest). Professional evaluators (e.g., the tasting panel of the Wine (...) Spectator, the Grand Jury Europ´een, virtually every judging panel in competitive wine events) routinely advertise that they use blind tasting exclusively. Wine books and tasting manuals at all levels consistently emphasize the importance of blind tasting. Thus, Michael Broadbent, perhaps the most prolific author of tasting notes in history, writes that “It is my firm opinion . . . that to assess the qualities of a wine by tasting it completely blind, without any hint of what it might be, is the most useful and salutary discipline that any self-respecting taster can be given” (quoted in ? , 156). Or, again, Ronald Jackson, in his industry-standard textbook on wine tasting, asserts categorically that “Tastings should always be conducted blind, usually with only the names of the wine noted in advance” ( ? , 334). (shrink)

Recently within the critical accounting literature Funnell (1998) has argued that accounting was implicated in the Holocaust. This charge is primarily related to the technical, mathematical nature of accounting and its ability to dehumanise individuals. Broadbent (1998, see also DeMoss and McCann, 1997) has also contended that "accounting logic" excludes emotion. She suggests that a more emancipatory form of accounting could be possible if emotion were given a voice and allowed to be heard within accounting discourse (see also Kjonstad (...) and Wilmott, 1995). This paper contends that emotion should be introduced into accounting education and in particular emotional commitment to other individuals should be encouraged. It is suggested that one way to do this may be through business ethics education. It is also suggested that increasing ethical commitment to other individuals may go some way towards combating the tendency for accountancy to dehumanise other people. While there have been specific studies of ethics and accounting education there has, as yet, been little open debate about what the objectives of accounting ethics education should be or the specific techniques that could be used to meet the desired aims. This paper contends that accountancy has become dangerously dehumanised and that one of the most important objectives for any business ethics education must be to develop an empathy with "the other". The paper studies the developments within the medical, legal and engineering profession in order to suggest some specific methods which could be employed in order to re-humanise accountancy and develop a sense of moral commitment towards other individuals. (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 myrecent book I have sought to define a notion of stability and to argue that it is a useful notion for biomedical and especially epidemiological research (Broadbent 2013, 56–80). In this paper I seek to defend the notion of stability against two possible objections: that it fails to be epistemically significant, and that it amounts to nothing more than empirical adequacy. I argue that stability is epistemically significant because to know that a hypothesis is stable is to know (...) something about the world, even if not the truth of the hypothesis. I argue that knowledge of stability of a hypothesis is distinct from knowledge of its approximate truth. And I argue that asserting the stability of a hypothesis is distinct from asserting its empirical adequacy, because it allows that the hypothesis may still be implicated in empirically inadequate claims, entailing only that if the hypothesis is so implicated, it will not be revised soon. (shrink)

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 →.

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)

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 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)

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)

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).

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)

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)

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)

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 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)

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)

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)