Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

Aging is an elusive property of life, and many important questions about aging depend on its definition. This article proposes to draw a definition from the scientific literature on aging. First, a broad review reveals five features commonly used to define aging: structural damage, functional decline, depletion, typical phenotypic changes or their cause, and increasing probability of death. Anything that can be called ‘aging’ must present one of these features. Then, although many conditions are not consensual instances of aging, aging (...) is consensually described as a process of loss characterized by a rate and resulting from the counteraction of protective mechanisms against mechanisms that limit lifespan. Beyond such an abstract definition, no one has yet succeeded in defining aging by a specific mechanism of aging because of an explanatory gap between such a mechanism and lifespan, a consensual explanandum of a theory of aging. By contrast, a sound theoretical definition can be obtained by revisiting the evolutionary theory of aging. Based on this theory, aging evolves thanks to the impossibility that natural selection eliminates late traits that are neutral mainly due to decreasing selective pressure. Yet, the results of physiological research suggest that this theory should be revised to also account for the small number of different aging pathways and for the existence of mechanisms counteracting these pathways, that must, on the contrary, have been selected. A synthetic, but temporary definition of aging can finally be proposed. (shrink)

Since the turn of the twenty-first century, biomedical psychiatry around the globe has embraced the so-called precision medicine paradigm, a model for medical research that uses innovative techniques for data collection and analysis to reevaluate traditional theories of disease. The goal of precision medicine is to improve diagnostics by restratifying the patient population on the basis of a deeper understanding of disease processes. This paper argues that precision is ill-fitting for psychiatry for two reasons. First, in psychiatry, unlike in fields (...) like oncology, precision medicine has been understood as an attempt to improve medicine by casting out, rather than merely revising, traditional taxonomic tools. Second, in psychiatry the term “biomarker” is often used in reference to signs or symptoms that allow patients to be classified and then matched with treatments; however, in oncology “biomarker” usually refers to a disease mechanism that is useful not only for diagnostics, but also for discovering causal pathways that drug therapies can target. Given these differences between how the precision medicine paradigm operates in psychiatry and in other medical fields like oncology, while precision psychiatry may offer successful rhetoric, it is not a promising paradigm. (shrink)

In Western countries today, a growing number of women delay motherhood until their late 30s and even 40s, as they invest time in pursuing education and career goals before starting a family. This social trend results from greater gender equality and expanded opportunities for women and is influenced by the availability of contraception and assisted reproductive technologies. However, advanced maternal age is associated with increased health risks, including infertility. While individual medical solutions such as ART and elective egg freezing can (...) promote reproductive autonomy, they entail significant risks and limitations. We thus argue that women should be better informed regarding the risks of advanced maternal age and ART, and that these individual solutions need to be supplemented by a public health approach, including policy measures that provide women with the opportunity to start a family earlier in life without sacrificing personal career goals. (shrink)

In this paper, we provide a macro level analysis of the visibility of philosophy of science in the sciences over the last four decades. Our quantitative analysis of publications and citations of philosophy of science papers, published in 17 main journals representing the discipline, contributes to the longstanding debate on the influence of philosophy of science on the sciences. It reveals the global structure of relationships that philosophy of science maintains with science, technology, engineering and mathematics and social sciences and (...) humanities fields. Explored at the level of disciplines, journals and authors, this analysis of the relations between philosophy of science and a large and diversified array of disciplines allows us to answer several questions: what is the degree of openness of various disciplines to the specialized knowledge produced in philosophy of science? Which STEM and SSH fields and journals have privileged ties with philosophy of science? What are the characteristics, in terms of citation and publication patterns, of authors who get their philosophy of science papers cited outside their field? Complementing existing qualitative inquiries on the influence of specific authors, concepts or topics of philosophy of science, the bibliometric approach proposed in this paper offers a comprehensive portrait of the multiple relationships that links philosophy of science to the sciences. (shrink)

Background Noninvasive prenatal testing (NIPT) provides important benefits yet raises ethical concerns. We surveyed Canadian pregnant women and their partners to explore their views regarding pressure to test and terminate a pregnancy, as well as other societal impacts that may result from the routinization of NIPT.Methods A questionnaire was offered (March 2015 to July 2016) to pregnant women and their partners at five healthcare facilities in four Canadian provinces.Results 882 pregnant women and 395 partners completed the survey. 64% of women (...) anticipated feeling no pressure to take the test if it were offered routinely, and 39% were not concerned about routinization leading to increased pressure to terminate a pregnancy of a fetus with Down Syndrome. Regarding other social concerns possibly resulting from routinization, pregnant women were most concerned regarding a reduction in resources available for people with Down Syndrome and their families and least concerned regarding a decrease in the population of people with Down Syndrome.Conclusions Our findings reflect the concerns expressed by pregnant women and their partners, both personal (pressure to test, pressure to terminate) and societal (e.g., regarding potential negative impact on people with disabilities and their families). Even if most women were not concerned about feeling pressured to test due to NIPT routinization, a large minority express concerns that should not be taken lightly. Moreover, a majority of respondents were concerned regarding pressure to terminate pregnancies due to NIPT routinization as well as regarding most societal impacts they were queried on, especially the possible future reduction in resources available for people with DS and their families. Canadian policy-makers should consider these potential negative ramifications of NIPT and ensure that appropriate social policies accompany its implementation. (shrink)

Following the neurophenomenological approach, we propose a model of emotional emergence that identifies the experimental structures of time involved in emotional experience and their plausible components in terms of cognition, physiology, and neuroscience. We argue that surprise, as a lived experience, and its physiological correlates of the startle reflex and cardiac defense are the core of the dynamic, and that the heart system sets temporally in motion the dynamic of emotional emergence. Finally, in reference to Craig’s model of emotion, we (...) propose an integrative model of the temporal dynamic of emotional emergence that allows emotions to be distinguished depending on each temporal phase and that involves the following three systems: the brain , the consciousness , and the doubled-sided continuum of the body-heart context, with the heart as the focus within the body during emotion. This model provides the framework for future developments in 1st- and 3rd-person approaches for an integrative understanding of the science of emotion, including the fields of psychophysiology and psychopathology. (shrink)

According to the received view, the transportation view, animal extrapolation consists in inductive prediction of the outcome of a mechanism in a target, based on an analogical mechanism in a model. Through an analysis of the failure of preclinical studies of TGN1412, an innovative drug, to predict the tragic consequences of its first-in-man trial in 2006, the received view is challenged by a proposed view of animal extrapolation, the chimera view. According to this view, animal extrapolation is based on a (...) hypothesis about how human organisms work, supported by the amalgamation of results drawn from various experimental organisms, and only predicting the ‘predictive grid’, that is, a global framework of the effects to be expected. (shrink)

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused on the task of (...) delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be? (shrink)

While many experts and organizations have recognized infertility as a public health issue, most governments have not yet adopted a public health approach to infertility. This article argues in favor of such an approach by discussing the various implications of infertility for public health. We use a conceptual framework that focuses on the dual meaning of the term ‘public’ in this context: the health of the public, as opposed to that of individuals, and the public/collective nature of the required interventions. (...) This analysis highlights the need for a comprehensive public health approach toward infertility, points to some initiatives that are already in place and demonstrates that prevention is currently a neglected—yet much needed——element. We move on to discuss the sensitive nature of prevention initiatives as a probable explanation for their scarcity. We illustrate the complexity of prevention through an analysis of an infertility prevention campaign previously conducted in the United States, which provoked significant controversy. We use a public health communication ethics framework to expose the strengths and the shortcomings of this campaign, and conclude that prevention initiatives targeting infertility can indeed be conducted in a sensible way that promotes autonomy while improving public health. (shrink)

Despite its vagueness Personalized, Precision, P4, P5, individualized, stratified medicine—or p-medicine in short—has become an increasingly popular term in biomedical literature. Philosophers have attempted to analyze what these various terms involve and have discussed consequences for medical practices. In this article, I argue that an important question remains unaddressed: what has made this project of p-medicine convincing to so many? My argument is that without real achievements, it would never have been. I also make the case that these achievements stem (...) from the domain of monoclonal antibodies, a new type of drug that justifies talks of personalized, precise, stratified, etc., medicine. In conclusion, while it may be possible to label any projection in the future of medicine as ‘p-medicine’, it is impossible to overlook mab-medicine as the spearhead. (shrink)

In our commentary on Lynch et al.’s target paper, we focus on decomposition as a research strategy. We argue that not only the presumptive microbial causes but also their supposed phenotypic effects need to be decomposed relative to each other. Such a dual decomposition strategy ought to improve the way in which causal claims in microbiome research can be made and understood.

In our commentary on Lynch et al.’s target paper, we focus on decomposition as a research strategy. We argue that not only the presumptive microbial causes but also their supposed phenotypic effects need to be decomposed relative to each other. Such a dual decomposition strategy ought to improve the way in which causal claims in microbiome research can be made and understood.

In our commentary on Lynch et al.’s target paper, we focus on decomposition as a research strategy. We argue that not only the presumptive microbial causes but also their supposed phenotypic effects need to be decomposed relative to each other. Such a dual decomposition strategy ought to improve the way in which causal claims in microbiome research can be made and understood.

The main thesis of this paper is that mental health practitioners can legitimately infer that a patient's given condition is a case of mental disorder without having diagnosed any specific mental disorder. The article shows how this is justifiable by relying either on psychopathological reasoning, on 'intentional' analysis or possibly on other modes of reasoning. In the end, it highlights the clinical and philosophical consequences of the plurality of modes of 'inferences to mental disorder'.

Harvey and Gurvir’s Law is a bill proposed to the Legislative Assembly of Ontario (Canada) to reduce stigma and bias associated with Down syndrome, by developing and disseminating quality information about Down syndrome in the context of prenatal testing.

We discuss the latent variables construct, particularly in regard to the following: that latent variables are considered as the sole explanatory factor of a disorder; that pragmatic concerns are ignored; and that the relationship of these variables to biological markers is not addressed. Further, we comment on the relationship between bridge symptoms and causality, and discuss the proposal in relationship to other constructs (endophenotypes, connectionist-inspired networks).

The Progress of the Left in Latin America: Governments, Social Movements, the Struggles of the Amerindian Populations Gérard Duménil and Michaël Löwy here interview Michel Lemoine about the nature of the governments currently in office in Argentina, Brazil, Uruguay, Bolivia and Venezuela. What contribution can these governments make to the task of establishing an anti-imperialist front? What are the specific features of the Latin American resistance to neo-liberalism, in view of the articulation between this resistance and the struggles of the (...) Amerindian populations? How is one to assess the manner in which Chavez defines and attempts to implement his project of a “socialism for the twenty-first century”. These are the principal questions addressed here. (shrink)

English summary: Based on the famous essay by Georges Canguilhem on what is normal and pathological (originally published in 1943), extensive philosophical literature (mainly Anglo-Saxon) has attempted to define these concepts and analyze their status. The main discussion focuses on the following question: can you describe health and illness as natural phenomena or are they states that are determined by values? French text. French description: Depuis le celebre essai de Georges Canguilhem sur le normal et le pathologique publie initialement en (...) 1943 et dont l'un des objectifs etait la clarification des concepts de sante et de maladie, une litterature philosophique abondante, principalement anglo-saxonne, s'est attachee a definir ces concepts et a analyser leur statut. Le principal debat de ce domaine emergent de la philosophie de la medecine porte sur la question: peut-on decrire la sante et la maladie comme des phenomenes naturels ou s'agit-il d'etats qui sont determines par des valeurs? Tous les textes presentes dans ce volume ont participe de cette controverse. Ceux de la premiere section accordent une part importante a la composante biologique. Ceux de la seconde donnent le primat a la notion d'action. Ceux de la derniere section mettent en question l'utilite ou la possibilite meme de definir les deux concepts. (shrink)

Philosophers of science have recently focused on the scientific activity of modeling phenomena, and explicated several of its properties, as well as the activities embedded into it. A first approach to modeling has been elaborated in terms of representing a target system: yet other epistemic functions, such as producing data or detecting phenomena, are at least as relevant. Additional useful distinctions have emerged, such as the one between phenomenological and mechanistic models. In biological sciences, besides mathematical models, models now come (...) in three forms: in vivo, in vitro and in silico. Each has been investigated separately, and many specific problems they raised have been laid out. Another relevant distinction is disciplinary: do models differ in significant ways according to the discipline involved—medicine or biology, evolutionary biology or earth science? Focusing on either this threefold distinction or the disciplinary boundaries reveals that they might not be sufficient from a philosophical perspective. On the contrary, focusing on the interaction between these various kinds of models, some interesting forms of explanation come to the fore, as is exemplified by the papers included in this issue. On the other hand, a focus on the use of models, rather than on their content, shows that the distinction between biological and medical models is theoretically sound. (shrink)

M. Henry voit à tort chez Maine de Biran la distinction entre trois figures du corps propre: corps objectif (extérieur et mondain), corps organique (terme résistant de l'effort), et corps subjectif (confondu avec l'ego). Maine de Biran distingue bien trois corps, mais le troisième, loin d'être confondu avec l'ego, est un corps de pure passivité duquel l'ego est absent. Cet état d'affectivité pure étudié par Biran répond à la critique par M. Henry de sa théorie de la passivité, et corrige (...) la théorie de l'auto-affection. M. Henry misunderstands Maine de Biran's distinction between three dimensions of the body: while the former makes a difference between the objective body (in the external world), the organic body (resistant term of the effort), and the subjective body (identified with the ego), the latter considers the third to be a body of mere passivity from which the ego is absent. The description Biran makes of this state of pure sensitivity answers M. Henry's critique of his theory of passivity, and modifies the theory of « auto-affection ». (shrink)

Philosophers of biology usually distinguish historical and systemic accounts of functions. In many areas of experimental biology the "systemic" account is often the most relevant. Yet there are problems this account does admittedly not face up to very well. My contention is that, though two minor problems are irredeemably unsolvable for the systemic account of function, the major ones can be solved by assuming that 'function' denotes (directly) a causal role in a model and (indirectly) the corresponding process in nature. (...) I try to show this through the analysis of the hypothalamus-pituitary-adrenal axis of stress. (shrink)

En France, l'épistémologie de la médecine est facilement réduite à l'étude du magistral essai de Canguilhem, Le normal et le pathologique. Toutefois, ce livre publié il y a plus de soixante-dix ans ne reflète plus l'état des sciences médicales contemporaines, ni celui des débats poursuivis par les philosophes des sciences depuis. Le présent livre, premier du genre en langue française, a pour ambition d'introduire le lecteur à la philosophie des sciences médicales. Ses dix chapitres initieront le lecteur aux débats qui (...) l'agitent, sans que soient requises des connaissances philosophiques ou médicales préalables. Il répond à la fois à la demande de médecins en quête d'une philosophie qui leur parle de leur discipline et de leurs pratiques, et de philosophes à la recherche d'un guide dans ce champ morcelé et dominé par la philosophie d'expression anglaise. [Payot]. (shrink)

La médecine ne se contente pas de diagnostiquer et de traiter des maladies : elle vise aussi à les expliquer. En cela, elle prend pied de plein droit dans le domaine de la science. En quoi consistent les explications médicales, et qu'est-ce qui les singularise au sein des explications en biologie? La première caractéristique des explications médicales est leur pluralité. La médecine semble en effet réunir sous un même label des explications très diverses, voire hétérogènes, unies seulement par l'objet d'application (...) et la visée thérapeutique. Le propre de l'explication scientifique médicale, c'est sa pluridisciplinarité.Un canevas théorique est nécessaire pour mettre en évidence ce qui, dans une explication scientifique, peut permettre une telle diversité des explications. Celui-ci est fourni par la notion de " valeur explicative " : une croyance, injustifiable, mais bien fondée, en l'exhaustivité des conditions initiales dont une explication doit tenir compte. Bien qu'elle tende par elle-même à tout expliquer sans reste, et qu'elle exclut du domaine disciplinaire qu'elle définit ainsi tout autre type d'explication, une valeur explicative n'exclut jamais en droit la possibilité d'explications scientifiques d'autres types. Un nombre indéfini de valeurs explicatives, exclusives les unes des autres, fondatrices de domaines scientifiques distincts, est donc possible. La médecine présente ainsi la particularité de rassembler plusieurs valeurs explicatives différentes et qui plus est, de les contraindre à la convergence ou à la collaboration. Quelques-unes des principales valeurs explicatives de la médecine sont présentées, de même que les enjeux de leur confrontation. Clinique, épidémiologique, mécanique, génétique, cytologique, infectiologique, pharmacologique, l'explication médicale se fonde à chaque fois sur une manière différente de considérer le phénomène pathologique. (shrink)

Because biologization of psychiatric constructs does not involve derivation of laws, or reduce the number of entities involved, the traditional term of ‘reduction’ should be replaced. This paper describes biologization in terms of redefinition, which involves changing the definition of terms sharing the same extension. Redefinition obtains through triangulation and calibration, that is, respectively, detection of an object from two different spots, and tweaking parameters of detection in order to optimize the picture. The unity of the different views of the (...) same object does not occur through derivation from one of them, as reduction suggests, nor does it obtain through mechanistic unity or the goal of explaining one mechanism, as the phrase ‘mosaic unity’ suggests. Instead, it depends on finding a specific angle of observation, from which linguistic consistency matches sound localization in the brain, so that all observations make sense together, just as an anamorphic picture makes clear sense only when observed from the right spot. (shrink)

Contrairement aux idées reçues, Hegel n’est pas un précurseur de la pensée totalitaire, auquel on pourrait opposer un Bergson républicain et démocrate. Tous deux parlent de la communauté politique comme d’un organisme, doctrine affectionnée du totalitarisme. Ni chez l’un, ni chez l’autre, on ne peut atténuer la portée de l’affirmation en invoquant un usage métaphorique : il faut entendre, chez l’un comme chez l’autre, l’organisme au sens propre mais large. L’organicité du politique, loin de la menacer, est la seule forme (...) compatible avec la liberté des individus, grâce à la distinction que l’on peut faire entre organisation toute faite et organisation se faisant : si la première traite les individus en rouages d’un mécanisme, la seconde est l’expression immédiate de l’épanouissement de leurs libertés.Popper wrote that Hegel, as a thinker, is a forerunner of totalitarianism ; on the other hand, one cannot but regard Bergson as a true democrat. Both however considered the politic body as an organism, a doctrine supporters of the totalitarian state favoured. The assertion must not be underrated : neither thinker intended to use a metaphorical expression, hence a broad meaning of « organism ». As a matter of fact the organicity of a politic body, far from threatening individual freedom, is the only form that proves compatible with individuality. The important thing is to distinguish all-made « organized organisation » from selfmaking « organizing organisation » : the former treats individuals as mechanical entities, while the latter is the result of the self-development of their freedom. (shrink)

La conception traditionnelle des théories scientifiques en philosophie de langue anglaise, qu’on appelle la « received view », et qui culmine au début des années 1960, posait de nombreux obstacles à une conception des théories scientifiques en biologie et en médecine. La conception sémantique des théories scientifiques qui lui succéda permit de lever ces obstacles, mais pas de différencier les théories en biologie expérimentale et en médecine. Le présent article met en évidence comment, en s’appuyant sur cette conception, Schaffner établit (...) la spécificité des théories biologiques et médicales par rapport aux théories physiques, comment Thompson établit que c’est le savoir biologique et non le savoir clinique qui, véritablement théorique, fonde le caractère proprement scientifique de la médecine, et enfin, comment Sadegh-Zadeh peut proposer à son tour des caractéristiques des théories médicales qui leur sont potentiellement spécifiques et les distinguent des théories biologiques. (shrink)

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as 'non-healthy', or of the healthy as 'non-pathological', can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the 'healthy'-'pathological' opposition, factual vs. rational, characterizes the ordinary usage of these concepts and (...) puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the 'healthy' and the 'pathological', it could explain some of the difficulties met in determining 'gold standards', in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as ‘non-healthy’, or of the healthy as ‘non-pathological’, can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the ‘healthy’–‘pathological’ opposition, factual vs. rational, characterizes the ordinary usage of these concepts and (...) puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the ‘healthy’ and the ‘pathological’, it could explain some of the difficulties met in determining ‘gold standards’, in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)