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)

This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with (...) natural balance. It is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (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)

Publisher: Philosophical Library Publication date: 1953 Subjects: Medicine Medical / Diseases Medical / General Medical / Diseases Medical / Microbiology Science / Life Sciences / Biology / Microbiology Notes: This is an OCR reprint. There may be typos or missing text. There are no illustrations or indexes. When you buy the General Books edition of this book you get free trial access to Million-Books.com where you can select from more than a million books for free. You can also preview the (...) book there. (shrink)

The dominance of the biomedically informed view of disability, genetics, and diagnosis is explored. An understanding of the social nature of disability and genetics, especially in terms of oppression, adds a richer dimension to an understanding of ethical issues pertaining to genetics. This is much wider than the limited question of whether or not such technology discriminates. Instead, it is proposed that such technology will perpetuate the oppression and control of people with disability, especially if the knowledge of people (...) with disability is not utilised in bioethical debates. (shrink)

The main objective of this paper was to examine the involuntary nature of music-evoked autobiographical memories. For this purpose, young adults, older adults, and patients with a clinical diagnosis of probable Alzheimer’s disease were asked to remember autobiographical events in two conditions: after being exposed to their own chosen music, and in silence. Compared to memories evoked in silence, memories evoked in the “Music” condition were found to be more specific, accompanied by more emotional content and impact on (...) mood, and retrieved faster. In addition, these memories engaged less executive processes. Thus, with all these characteristics and the fact that they are activated by a perceptual cue , music-evoked autobiographic memories have all the features to be considered as involuntary memories. Our paper reveals several characteristics of music-evoked autobiographical memories in AD patients and offers a theoretical background for this phenomenon. (shrink)

Hysteria was a frequently diagnosed illness in the West through the nineteenth and much of the twentieth century. Today the medical profession has virtually abandoned the diagnosis altogether. However, this does not mean that hysteria has ceased to exist. In _The Nature of Hysteria_, Niel Micklem argues that the disease has merely shifted into other personal and collective forms. He traces the history of hysteria from ancient Egyptian times to the present and examines its mythic background. He also (...) describes the involvement of sexuality in the clinical manifestations of hysteria to witchcraft, and various collective manifestations of hysteria in the form of sexual permissiveness and unisexual behaviour. Arguing that hysteria is much more than an illness, Niel Micklem suggests that the denial of hysteria in individual patients has coincided with the creation of an increasingly hysterical society. (shrink)

We defend a view of the distinction between the normal and the pathological according to which that distinction has an objective, biological component. We accept that there is a normative component to the concept of disease, especially as applied to human beings. Nevertheless, an organism cannot be in a pathological state unless something has gone wrong for that organism from a purely biological point of view. Biology, we argue, recognises two sources of biological normativity, which jointly generate four “ways (...) of going wrong” from a biological perspective. These findings show why previous attempts to provide objective criteria for pathology have fallen short: Biological science recognizes a broader range of ways in which living things can do better or worse than has previously been recognized in the philosophy of medicine. (shrink)

In Patricia Churchland's 2006 essay on free will, she cites the case of a middle-aged man who, without any prior history of misbehavior, suddenly became obsessed with child pornography and started to molest his 8-year-old stepdaughter. He was subsequently discovered to have a brain tumor affecting the frontal lobes, and when it is successfully treated his aberrant behavior stopped.Thomas Szasz is famous for his denunciation of the concept of mental illness, and his critique is partly responsible for instigating an enduring (...) philosophical discourse about the nature of mental disorder. Szasz's key insight was the recognition that we find it important to distinguish between situations that are characterized by... (shrink)

In the discussion of such social questions as how should alcoholics be treated by society? and what kind of people are responsible in the face of the law?, is disease a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance alcoholism should be classified as a disease we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases, (...) and therefore we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden. (shrink)

What, according to Locke, are ideas? I argue that Locke does not give an account of the nature of ideas. In the Essay, the question is simply set to one side, as recommended by the “Historical, plain Method” that Locke employs. This is exemplified by his characterization of ‘ideas’ in E I.i.8, and the discussion of the inverted spectrum hypothesis in E II.xxxii. In this respect, Locke's attitude towards the nature of ideas in the Essay is reminiscent of (...) Boyle's diffident attitude towards the nature of matter. In posthumously published work, however, Locke suggests that the enquiry into the nature of ideas is one of the things that the enquiry into the extent of human knowledge undertaken in the Essay actually shows to lie beyond the “compass of human understanding”. In this respect, Locke's attitude towards the nature of ideas is reminiscent of Sydenham's attitude towards the nature of diseases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Nature of Proof in PsychiatryPaul Lieberman (bio)Keywordspsychotherapy process, knowledge and psychiatry, externalism, WittgensteinThis vivid clinical report illustrates recognizably, and provocatively, a number of routine, but often unexamined, clinical questions. In its few paragraphs, it depicts challenges that each practitioner confronts, and, in the flux of clinical work, addresses, however implicitly and imperfectly, every day: From what data, and by what processes, does a clinical formulation, or way (...) of understanding, come into being? How do we appraise its accuracy and adequacy? Of what value is even a well-substantiated understanding, in the mind of the therapist, to the patient? What is the power of empathy as a treatment tool? How do we assess someone's status as a “good candidate for therapy?” When, typically, only the outlines of a problem are visible, and its origins and implications are largely hidden, by what right do we recommend psychotherapy, and with what conception, at what level of detail, of what its outcome will be? These are among the questions that Dr. Bailey's story challenges us to address.They are clinical questions, of course, because they deal with empirical matters of fact—psychological processes, outcomes studies, and evidence. But they are also philosophical because, as Freud insisted and Dr. Bailey shows, information obtained in the clinical situation often has power and authority that lead us to believe we understand what is going on, understand the other person, even in the absence of scientifically tested hypotheses, or the clear application of research-based evidence. Interactions between people—including clinical interactions—have a life and ability to engage us. Their meanings can seem so transparent and convincing that no doubt or questioning may seem cogent. At their most powerful, such experiences can reawaken us to important realms of experience and feeling which we might, otherwise, forget, ignore, suppress, deny, or in other ways keep out of awareness; they have the potential to arouse us and reconnect us with truths that, once revived, can seem both valid and important—perhaps the kind of experience that we may derive from works of art or literature (in fact, Dr. Bailey's account could be seen as a clinical parable—meant to be neither true nor false, but instructive). But even less dramatic examples are commonplace: we do routinely claim to know and be able to interpret and understand the actions of other people from our everyday interactions with and observations of them.What is less clear is how to account for these convictions and how to appraise their value, because they do not derive from established scientific procedures. Clinical intuition has a role throughout medicine, but we usually expect it to be subjected later to more rigorous tests to establish the correct diagnosis. Yet, as Dr. Bailey's case illustrates, clinical intuition in the psychiatric encounter seems somehow different. When Colin [End Page 225] leads Dr. Bailey to the conclusion that a “painful lack of wounds” has made him depressed, we find this credible. It seems similarly credible that Dr. Bailey might be anxious about his own capacity to defend his young family, because he says he is, that he perceives Colin as testing his manhood or sincerity, because that seems to fit Colin's temperament, that being accurately understood is helpful, because most of us have had that experience and valued it, and that, most generally, an absence of challenge or of activity could be depressing. But suppose a patient believed that a painful lack of wounds produced diabetes instead of depression, or suppose he had developed epilepsy and attributed that to an absence of combat experience. We might see these as ‘pre-scientific’ or ‘hypothesis-generating’ (or worse). By contrast, it seems timid to consider psychiatric formulations to be always and only provisional or hypothetical.In what ways and to what extent should we expect psychiatry to be different, and why? Several considerations suggest that psychiatry's reasons are not, always and everywhere, the same as those of general medicine, nor are its objectives.In general medicine, we distinguish between signs and symptoms, on the one hand, and “underlying” disease processes, on the other. But in psychiatry, this distinction can be... (shrink)

A significant portion of newborns cared for in the neonatal intensive care unit or other ICUs, such as the cardiac ICU, have a medical condition with a genetic component, including congenital malformations, the leading cause of death in the NICU. In many cases, however, it is not clear which condition the child has or what can be done to help him or her. Genomic sequencing of sick newborns has the potential to bypass the prolonged journey to a diagnosis, improving the (...) medical care of individual infants. Sequencing also has the potential to benefit others beyond the child whose genome is sequenced and his or her immediate family. Sequence data from sick newborns will expand medicine's understanding of genetic diseases, leading to improvements in clinicians’ ability to counsel family and to provide even more targeted care. Not only will more frequent use of sequencing lead to discovery of new genes; it will also provide unique insights into the full spectrum of known Mendelian genetic diseases, so‐called phenotypic expansion, when a gene previously recognized as associated with a phenotype is found to be associated with an expanded set of clinical features. Genetic and environmental changes that modify the expression of a genetic disease may also be elucidated. (shrink)

Current research in molecular epidemiology uses biomarkers to model the different disease phases from environmental exposure, to early clinical changes, to development of disease. The hope is to get a better understanding of the causal impact of a number of pollutants and chemicals on several diseases, including cancer and allergies. In a recent paper Russo and Williamson address the question of what evidential elements enter the conceptualisation and modelling stages of this type of biomarkers research. Recent research in (...) causality has examined Ned Hall’s distinction between two concepts of causality: production and dependence. In another recent paper, Illari examined the relatively under-explored production approach to causality, arguing that at least one job of an account of causal production is to illuminate our inferential practices concerning causal linking. Illari argued that an informational account solves existing problems with traditional accounts. This paper follows up this previous work by investigating the nature of the causal links established in biomarkers research. We argue that traditional accounts of productive causality are unable to provide a sensible account of the nature of the causal link in biomarkers research, while an informational account is very promising. (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the (...) boundary between the two categories; and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

According to the ‘fact-plus-value’ model of pathology propounded by K. W. M. Fulford, ‘disease’ is a value term that ought to reflect a ‘balance of values’ stemming from patients and doctors and other ‘stakeholders’ in medical nosology. In the present article I take issue with his linguistic-analytical arguments for why pathological status must be relative to such a kind of medico-ethical normativity. Fulford is right to point out that Boorse and other naturalists are compelled to utilize evaluative terminology when (...) they characterize the nature of diseases and biological dysfunctions. But the relevant ‘biofunctional judgements’ are no less factual and empirical for that. While it is indeed evaluative to say that biological dysfunctions involve failures to execute naturally selected functions, such judgments are not bound to entail anything about what is good or bad for us, and what should be treated or not. In the last part of the paper I ruminate briefly on the relationship between ‘biological evaluationism’, on my construal, and descriptions of ‘causal biology’. As I note in my conclusion, a strict bioevaluative concept of disease can be valid for every species on earth, and thus be of particular usefulness in general biological contexts. (shrink)

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of (...) the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

The question of whether medical and psychiatric judgements involve a normative or evaluative component has been a source of wide and vehement disagreement. But among those who think such a component is involved, there is considerable further disagreement as to its nature. In this article, I consider several versions of Aristotelian normativism, as propounded by Christopher Megone, Michael Thompson and Philippa Foot, and Martha Nussbaum. The first two, I claim, can be persuasively rebutted by different modes of liberal pluralist (...) challenge — respectively, pluralism about structures of social organisation and pluralism about biological forms. Nussbaum's version, by contrast, is alert to the need for pluralism; I argue, however, that the Aristotelian aspects of her theory hamper her pursuit of those pluralistic aims. (shrink)

Language used to describe measles in the press has altered significantly over the last sixty years, a shift that reflects changing perceptions of the disease within the medical community as well as broader changes in public health discourse. California, one of the most populous U.S. states and seat of the 2015 measles outbreak originating at Disneyland, presents an opportunity for observing these changes. This article offers a longitudinal case study of five decades of measles news coverage by the Los (...) Angeles Times and the San Francisco Chronicle, which represented two of the largest news markets in California when the measles vaccine was released, in 1963, and during the 2015 outbreak. Measles reporting during this period displays patterns pointing to an active role for journalists in shaping public understanding of health and medical matters, especially as they recede from public memory, through the employment of available and circulating political and cultural frames. Moreover, journalistic frames in this period of reporting incorporated presentist descriptions of the disease, which imposed present values on the medical past, and which were constructed of decontextualized historical references that supported prevailing contemporary notions of the disease. Framing and the tendency toward presentism, in the context of shifting public health discourse, had the effect of communicating an increasingly severe sounding disease over time, and of shifting blame for that disease’s spread from nature to government to individuals. Journalistic framing and causal stories have much power to shape public understanding of medical matters as they recede from public memory. (shrink)

This paper contends, following Plato and Broekman, that seeing images as images is crucial to theorizing medicine and that considering clinical pictures as images of images is a much-needed epistemic complement to the domineering view that sees clinical pictures as mirrors of disease. This does not only offer epistemic, but also ethical benefits to individual patients, especially in those cases where patients suffer from chronic, debilitating, and terminal illnesses and where medicine provides no, or limited, answers in terms of (...) treatment, intervention, and meaning. By creating room for a theory of clinical pictures that rightfully emphasizes its pictorial nature, patients and doctors alike may be encouraged to consider under what authorship, and with which epistemic tools, alternative, supplemental images may be produced to get at the existential reality of disease and suffering. Ultimately, this paper argues that the epistemic tools provided by aesthetics may offer such glimpses into the reality of disease and suffering, and I conclude by discussing a few artistic renditions of breast cancer to illustrate my point. (shrink)

"Every man has his particular way of being in good health" - Emanuel Kant. Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well-being’. It is odd to define ‘health’ (...) as a negative state that puts it beyond the reach of everyone. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. (shrink)

In this paper, I focus on life-threatening medical conditions and argue that from the point of view of natural properties, induction(s), and participation in laws, at least some of the ill organisms dealt with in somatic medicine form natural kinds in the same sense in which the kinds in the exact sciences are thought of as natural. By way of comparing two ‘divisions of nature’, viz., a ‘classical’ exact science kind (gold) and a kind of disease (Graves (...) class='Hi'>disease), I show that there is no justifiable ‘ontological gap’ between disease kinds and exact sciences kinds. We have instead a difference of degree. (shrink)

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)

, Lawrie Reznek argues that disease is not a natural kind term. I raise objections to Reznek's two central arguments for establishing that disease is not a natural kind. In criticizing his a priori, conceptual argument against naturalism, I argue that his conclusion rests on a weaker argument that appeals to the empirical diversity in the symptoms and manifestations of disease. I also raise questions about the account of natural kinds which Reznek utilizes and his point that (...) conventions for classification are excluded by there being natural kinds. Keywords: Disease, natural kind, value judgement CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Elvira Panaiotidi, “The Nature of Paradigms and Paradigm Shifts in Music Education”Wenyi W. KurkulAt the beginning, I would like to congratulate Elvira Panaiotidi on her interesting paper and on her proposal to move beyond the long-running debates that began in the mid-1990s between Bennett Reimer and David Elliott and their respective supporters. I also applaud her affirmation that, beyond the numerous debates within the music-education philosophy (...) community, the ultimate goal is to put the theories to work in schools or, in other words, to convert theories into operative paradigms.Echoing her affirmation, I shared her article with a class of my graduate students after I received the invitation to respond to this paper. All of my graduate students are current schoolteachers in the greater Washington, DC metropolitan area in the United States. Some of them are young teachers; others have decades [End Page 114] of teaching experience. As a university professor, I have always been thrilled by how much my thoughts are inspired by my students—by their stories, writing, discussions, dialogues, and sometimes very challenging questions in class. Their concern for their daily jobs and their students constantly remind me of our responsibilities to the children in the schools. However, with our schools and students in mind, I have to ask the music education philosophy community a question: Is "producing a unified concept of music," or "searching for a unified approach," or even aiming to "develop a unified approach in music education" as proposed by Panaiotidi what we truly need?In her paper, Panaiotidi discusses the debate over the approaches in music education by Reimer and Elliott in the context of paradigm shifts. The term, "paradigm shift," was introduced by Thomas Kuhn in 1962 in his highly influential book, The Structure of Scientific Revolutions. Kuhn proposes that almost every significant break-through in the field of scientific endeavor is first a break with tradition, with old ways of thinking, with old paradigms. For example, until the germ theory was developed, there was a high percentage of deaths during childbirth and scientists were not sure why. Likewise, in military settings, more people were dying from small wounds and diseases than from the major traumas experienced on the frontlines. But as soon as the germ theory was developed, a whole new paradigm—a better, improved way of understanding what was happening—made dramatic and significant improvements in the practice of medicine possible.The United States today is the setting for another fruitful and powerful example of a dramatic paradigm shift. The traditional concept of government had been monarchical, based on the divine right of kings. It was not until centuries later that a significant break-through paradigm was developed: government of the people, by the people, and for the people. A constitutional democracy was born that unleashed tremendous human energy and ingenuity. This new paradigm, over time, generated personal empowerment, free enterprise, a higher standard of living, freedom and liberty, and influence and hope unequaled in the history of the world.Stephen R. Covey, the author of a popular book in the late 1980s, The Seven Habits of Highly Effective People, cites Kuhn's conception of paradigm shift to illustrate his own ideas. He describes an experiment at the Harvard Business School in which an instructor passed out a picture of a young woman to half of the class and a picture of an old woman to the other half. The students were asked to look briefly at the picture and pass it back. The professor then asked the class to describe the woman as he projected on a screen a picture of a woman that was a combined image of the "old" and "young" women. Needless to say, the students debated the age of the woman. If they had seen the "young" version, [End Page 115] they could see only a young woman now, and vice-versa. Each student was adamant about his or her position. They did not see the image in another way until the lines were pointed out to demonstrate the features of the old and young woman. Covey cites this exercise to prove the powerful conditioning effects of one... (shrink)

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, (...) since the failure of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard. (shrink)

In this article, I draw on my fieldwork creating protein models of hepatitis B at a biotech laboratory to think through how to approach the body and disease from ontological and phenomenological perspectives. I subsequently draw on Mariella Pandolfi’s work on how bodies can be made to suffer history and Paul Farmer’s work on global tuberculosis disparities to explore ways of analysing embodied activity as a means of identifying and clinically addressing enactments of social inequality and disease. I (...) also introduce Merleau-Ponty’s phenomenological concept of ‘flesh’ as a conceptual heuristic that allows us to understand the meaningful structuring of ontological worlds beyond our own. As I argue, bringing these perspectives together not only allows us to re-envision what an effective disease treatment should be in diverse medical contexts, but also how to better understand health disparities and the nature of disease itself. (shrink)

Philosophical debates about the concept of disease, particularly of mental disease, might benefit from reconsideration and a closer look at the established terminology and conceptual structure of contemporary medical pathology and clinical nosology. The concepts and principles of medicine differ, to a considerable extent, from the ideas and notions of philosophical theories of disease. In medical theory, the concepts of disease entity and pathologicity are, besides the concept of disease itself, of fundamental importance, and they (...) are essentially connected to the concepts cause of disease or etiological factor, natural course or natural history of disease, and pathological disposition. It is the concept of disease entity that is of key importance for understanding medical pathology and theory of disease. Its central role is shown by a short reconstruction of its main features and its intrinsic connection to the concept of pathologicity. The meaning of pathologicity is elucidated by explicating the underlying criteria. (shrink)

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. (...) class='Hi'>Disease can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

If you consult a medical textbook to learn about the pathogenesis of Lyme disease, you will find a standard narrative. You will learn the disease is caused by the spirochete Borrelia burgdorferi, which is transmitted to people by blacklegged ticks . You will also learn that the natural reservoir for spirochetes in the Northeast is the white-footed mouse , and also likely be told that white-tailed deer are the primary host for gravid female ticks. And that is pretty (...) much the whole story. This limited perspective that considers only four species—spirochetes, mice, ticks, and deer—is entrenched by a reductionist paradigm, one that belies the nature of a .. (shrink)

Paul Griffiths and John Matthewson argue that selected effects play the key role in determining whether a state is pathological. In response, it is argued that a selected effects account faces a number of difficulties in light of modern genomic research. Firstly, a modern history approach to selection is problematic as a basis for assigning function to human traits in light of the small population sizes in the hominin lineage, which imply that selection has played a limited role in shaping (...) these genomes in the evolutionarily recent past. Secondly, determining both the genetic basis of disease and selective histories of the various alleles involved may be experimentally intractable. Thirdly, the existence of “selected disorders” is well supported, and yet on the other hand many other common diseases may not reduce evolutionary fitness. In summary, the biological ends promoted by natural selection, as best modeled in recent research, do not adequately ground a concept of dysfunction that aligns well with the interests of human health. (shrink)

The ongoing COVID-19 pandemic has brought science to the fore of public discourse and, considering the complexity of the issues involved, with it also the challenge of effective and informative science communication. This is a particularly contentious topic, in that it is both highly emotional in and of itself; sits at the nexus of the decision-making process regarding the handling of the pandemic, which has effected lockdowns, social behaviour measures, business closures, and others; and concerns the recording and reporting of (...) disease mortality. To clarify a point that has caused much controversy and anger in the public debate, the first part of the present article discusses the very fundamentals underlying the issue of causative attribution with regards to mortality, lays out the foundations of the statistical means of mortality estimation, and concretizes these by analysing the recording and reporting practices adopted in England and their widespread misrepresentations. The second part of the article is empirical in nature. I present data and an analysis of how COVID-19 mortality has been reported in the mainstream media in the UK and the USA, including a comparative analysis both across the two countries as well as across different media outlets. The findings clearly demonstrate a uniform and worrying lack of understanding of the relevant technical subject matter by the media in both countries. Of particular interest is the finding that with a remarkable regularity (????>0.998), the greater the number of articles a media outlet has published on COVID-19 mortality, the greater the proportion of its articles misrepresented the disease mortality figures. (shrink)

Since the publication of Kuhn’s The Structure of Scientific Revolutions in 1962, the notion of paradigms has shaped the way that philosophy views scientific discovery and how changes in what is regarded as empirical fact occur. This drew heavily on examples from the history of the natural sciences to support Kuhn’s hypothesis. However, some argue that medicine is different from the natural sciences. Gillies has proposed another theory of how paradigms apply to medicine; that of composite paradigms. In doing so, (...) Gillies uses the example of Helicobacter pylori and the shift from the excess-acid theory to the current bacterial-infection theory of gastric ulcers to illustrate these fundamental differences between medicine and the natural sciences.Upon analysis of Gillies’ claim, it is evident that traditional Kuhnian paradigms are also composite and that the manner in which Gillies proposes disease is classified is insufficient in describing medicine. Furthermore, new local paradigms are demonstrably introduced and the change was accompanied by many of the markers of paradigmatic change including changes in worldview, resistance, incommensurability and the introduction of new questions that could not have existed under the previous paradigm. Whilst this change may not be on the scale of the Chemical revolution, it can still be considered paradigm shift.Thagard also proposes an alternate view of discovery using the case of H. pylori. This has much in common with Kuhnian paradigms but Thagard’s theory offers further elucidation and refinement. This allows it to better characterise all of the associated features of discovery relevant in the case of H. pylori, thus provides a preferable tool for examination of this important recent discovery. (shrink)

Russell Powell and Eric Scarffe1 are pluralists about disease. They offer their thickly normative account to meet the needs of doctors, but they allow that a different concept of disease might work better for zoologists. In this commentary, I grant that Powell and Scarffe’s thickly normative evaluation of biological dysfunction works well in many medicinal contexts. Powell and Scarffe respond effectively to eliminativists—we should retain the concept of disease. But the paper’s pluralism and focus on the specific (...) needs of institutions should permit us to eliminate the notion of disease from domains for which the historical grounding of their selected effects account of function are contrary to therapeutic goals. One such domain is mental health. I found Powell and Scarffe’s rejection of Boorse’s dispositional account of biological function persuasive—the selected effects account of function is a superior fit for biologists’ use of the term. But the historical nature of this concept is, at best, a distraction from the task of morally evaluating the many ways in which …. (shrink)

Attempts to formalize the diagnostic process are by no means a recent undertaking; what is new is the availability of an engine to process these formalizations. The digital computer has therefore been increasingly turned to in the expectation of developing systems which will assist or replace the physician in diagnosis. Such efforts involve a number of assumptions regarding the nature of the diagnostic process: e.g. where it begins, and where it ends. ‘Diagnosis’ appears to include a number of quite (...) different cognitive processes, some of which seem more subject to formalization than others. Underlying the difficulties inherent in these efforts at formalization, is the hierarchical structure of medical knowledge including that of diseases. (By ‘hierarchical structure’, I mean no more than that our descriptions of clinical objects necessarily refer to different levels of organization; atomic, molecular, cellular, physiological system, entire patient.) Since diagnosis is in part a form of classification, measures of similarity between the clinical findings of a particular patient and a potential disease, are needed. This is complicated by the fact that some diseases are described using the vocabularies of physics and chemistry, others with the vocabulary of psychology, and most, with terms taken from a number of different hierarchical levels. The differences between the descriptions made using these vocabularies will be seen to exert systematic (if not uniform) influences upon the diagnostic process. CiteULike Connotea Del.icio.us What's this? (shrink)

In light of the human genome project, establishing the genetic aetiology of complex human diseases has become a research priority within Western medicine. However, in addition to the identification of disease genes, numerous research projects are also being undertaken to identify genes contributing to the development of human behavioural characteristics, such as cognitive ability and criminal tendency. The permissibility of this research is obviously controversial: will society benefit from this research, or will it adversely affect our conceptions of ourselves (...) and each other? When assessing the permissibility of this research, it is important to consider the nature and deterministic significance of behavioural genetic information. Whilst todate there has been much discussion and debate about the properties of genetic information per se and genetic determinism, this has not been applied to behavioural genetic research and its ethical implications. Therefore, this paper elucidates how behavioural genetic information can be distinguished from other types of genetic and non-genetic information and also synthesises the determinative significance of genetic factors for the development of human behavioural traits. Undertaking this analysis enables the ethical issues raised by this research to be debated in an appropriate context and indicates that separate policy considerations are warranted. (shrink)

Securitization of infectious diseases may involve suspension of ordinary human rights and liberties. In the event of an epidemic, therefore, it is important to limit the occasions upon which draconian disease control measures are implemented in the name of security. The term ‘security’, moreover, should not be used too loosely if it is to retain force and meaning in political discourse. It may be argued that the bar for disease securitization should be set high so that it is (...) limited to contexts involving rapidly spreading pathogens. Such an approach, however, would rule out securitization of more slowly spreading, endemic diseases such as HIV/AIDS. An advantage of characterizing HIV/AIDS as a security threat in developing countries, where the burden of the disease is concentrated, is that this is likely to mobilize resources needed to improve the situation there. That is, if HIV/AIDS is convincingly framed as a security threat, then governments may recognize self‐interested reasons to ramp up control measures. Following consideration of arguments for narrow (excluding HIV/AIDS) versus broad (including HIV/AIDS) conceptions of security, we conclude that the legitimacy of ‘securitizing’ HIV/AIDS ultimately turns on empirical and semantic issues, and we emphasize the importance of distinguishing (1) the nature of the threat posed by HIV/AIDS and (2) the measures required to address that threat. (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)

The study of social, ethical, and political issues from a naturalistic perspective has been pervasive in social sciences and the humanities in the last decades. This articulation of empirical research with philosophical and normative reflection is increasingly getting attention in academic circles and the public spheres, given the prevalence of urgent needs and challenges that society is facing on a global scale. The contemporary world is full of challenges or what some philosophers have called ‘existential risks’ to humanity. Nuclear wars, (...) natural and/or engineered pandemics, climate change, global totalitarianism, and emergent technologies, are some of the challenges mentioned by many authors devoted to the study of long-term potential risks for the survival of the human species. However, while there are many reasons to be a pessimist about the future of humanity, there is also a lot of ink wasted in showing that the world today is far better than we had in the past and also that there have been many instances of social and moral progress in the last centuries. Some authors have even claimed that “we have made more progress over the last 100 years than in the first 100,000”. According to ‘our world in data’, some of the most relevant advances of humanity in the last centuries have to do with the reduction of poverty and/or inequality, better health and security, the decline of violence and war, and the development of democracy and institutional mechanisms to guarantee individual freedom and rights. Yet, there is a more concrete concern that our world faces nowadays, and requires a particularly detailed analysis. In a few words, the advance in information and communication technologies, the huge volume of people migration because of prevalent instances of global inequality, and the reality of an interconnected world that just mirrors an extensive history of massive human intergroup relations open the question about the feasibility of social and moral progress in the contexts of diverse, multicultural, and unequal societies. This makes it crucial to reflect not only on whether human societies may keep advancing on a path of social progress, but how this can be achieved by addressing the challenges of inequality and potential intergroup conflict. This concern closely relates to the further consolidation of democratic values and the achievement of a more generalized consideration of the equal moral value of human individuals far from group, ethnic, or collective distinctions. This vision of progress follows the moral convictions that have been considered right and worthy to be pursued by most ethical theories explored by philosophers and social scientists so far. This work aims to contribute to the study of the mechanisms and feasibility of social and moral progress grounded on the precept of human equality and is guided by the idea that social and moral progress in a plural world requires the accomplishment of a more democratic and tolerant society. These forms of progress have already been defined by philosophers Allen Buchanan and Russel Powell as inclusivist forms of moral progress. According to these authors, inclusivist moral progress is featured by the transformation of moral judgments, motivations, and norms guided by the rejection of “group-based restrictions on moral standing and moral status” (2018). The work of Buchanan and Powell is fundamental for the argumentation developed in this work since they have pioneered a more complex debate in the field of evolutionary social sciences and philosophical anthropology. In brief, these authors have inquired how human nature, conceptualized by the advances in evolutionary thinking and the empirical sciences, is related to our moral convictions and the possibilities that we have to establish certain forms of social and moral progress. The work of Buchanan and Powell contributes to the debate on moral progress by incorporating empirically-informed concepts and arguments. With this objective in mind, they develop their discussion around a generalized tension between exclusivist and inclusivist forms of moral progress. This tension revolves around the question of whether and to what extent human moral concerns, motivations, and norms, are limited or bounded by social identities, group thinking, or collective values. This question is at the center of this work. In other words, I aim to answer whether and to what extent the nature of our social and moral cognition hinders or enables the development of inclusivist forms of morality and moral progress. As I mentioned so far, the distinction between exclusivist and inclusivist forms of morality has a practical implication and facilitates the reflection on the mechanisms and feasibility of concrete forms of progress based on the precept of human equality, which is the road to progress that we should follow according to most ethical theories. The distinction between exclusivist and inclusivist morality is not used here as a form of summarizing highly divergent descriptive approaches to morality, but as a way to address the practical implications of morality research, particularly around the question of the feasibility of social forms of progress based on the precept of equality and tolerance. My objective then has less to do with offering a conceptualization of human morality or with the proposition of a new ethical perspective. Instead, I aim to identify, from an empirically informed perspective, what enables the achievement of egalitarian forms of social progress, to subsequently offer a normative reflection about what we should do if we want to accomplish such inclusivist forms of progress. This task is of great relevance, having in mind that some theoretical proposals on the matter have claimed that human prosocial behavior and morality are constrained by exclusivist fixed tendencies as a product of our evolutionary history. According to these views, human morality is a group-centered cognitive and behavioral expression that has severe limits in its scope and extent, which hinders in the end the emergence of inclusivist forms of moral concerns and behaviors. These claims align with the philosophical intuition about the ‘dissociation of empathy’, or the fact that human individuals tend to express empathy and sympathy preferably for members of their group whereas their empathic and moral concern and recognition for outgroup individuals tend to be reduced or eliminated in real-life social interactions. Multiple theorists have expressed, however, that these assumptions are wrong for empirical and philosophical reasons, which results in a serious challenge to the conception of human morality as exclusivist by nature. Furthermore, simple intuition and practical experience constantly show us that human individuals can develop and endorse a broad spectrum of moral considerations and adopt an arguably inclusivist stance concerning the kind of persons or agents that deserve moral concern. Moreover, and adopting a historical perspective, the expansion of cultural and commercial exchanges, the consolidation of democracy, the development of welfare states, or the emergence of institutions based on the concept of universal human rights, have partially driven human progress based on the impartial concern for the well-being of persons. These historical instances of cultural evolution and institutional design have shown that it is feasible to promote behaviors and attitudes grounded in impersonal prosocial and inclusivist principles. This optimistic perspective, however, still begs the question of the exact relationship between social, cultural, and historical contexts, and the emergence of certain behavioral expressions of inclusivist morality. This is crucial since a great number of human individuals around the world still do not make part of these instances of social progress, and some authors have suggested that such instances of social and moral progress are particularly favored by the contexts of the WEIRD world, that is the world of Western, Educated, Industrialized, Rich, and Democratic societies. Some of these approaches consider moral inclusivity a ‘luxury good’ and follow the ‘dependency thesis’ according to which the expression of moral inclusivity depends on the presence of very concrete material conditions that trigger inclusivist and impersonal prosocial tendencies that human beings are not able to express in threatening contexts without physical security. This thesis is problematic for various reasons and has led to incomplete explanations about the enabling and causal factors of inclusivist moral progress, as well as unsatisfactory suggestions about what we should do to foster the accomplishment of more generalized instances of progress based on inclusivist concerns. In an attempt to contribute to this debate, the main objective of this thesis is to offer an alternative proposal about the nature of human morality and a more detailed reflection on what we should do if we want to further accomplish such instances of progress. More precisely, this work adopts a particular developmental and constructivist vision of human morality to answer the question of how feasible it is to reach generalized forms of social progress based on the precepts of moral inclusivity. Furthermore, it offers some ideas about what are the most adequate and favorable conditions to foster such progress both at the individual and the collective level. At this point, a preliminary clarification of some starting points is necessary. In the first place, and contrary to what other authors have proposed when debating moral progress from an empirically-based approach, my perspective adopts a radical developmental and constructivist perspective, following particularly the conceptual and empirical ideas of the social-domain theory in moral psychology. From this perspective, morality is a domain of normative and social knowledge that develops and emerges in human interactions. Moral concerns, judgments, and norms are not only the result of the expression of innate adaptive intuitions, nor the product of social conformity and a simple process of mirroring the normativity that communities have established to organize their social life. Human individuals, instead, construct moral concerns and judgments during their situated interactions. More specifically, the constructivist tradition claims that we need to research how moral concerns, judgments, and reasons emerge in social interactions and how human beings construct the content of their moral knowledge in the first place. Based on these ideas, morality is defined here as the result of a constructive process through which human individuals, by the means of constant interactions on a background of mutual respect and recognition, develop evaluative concerns about how we ought to treat others, and how to ‘care’ and ‘respect’ others’ well-being, needs, and vulnerabilities. This developmental-constructivist theory of human psychology contributes to an alternative understanding of the origins of moral variability and informs a very particular normative stance about the most desirable contexts needed for the urgent accomplishment of inclusivist forms of morality in contemporary societies. This is so given that the very same definition of morality adopted presupposes the feature of inclusivity. The main objective of this work is then to argue, based on a developmental perspective, what are the most favorable conditions to foster the development of moral inclusivity and what we should do to accomplish concrete instances of moral progress that truly help us to overcome our most urgent moral challenges. The whole thesis is organized as follows. In part I, I show how received visions about human social evolution have informed conceptions of morality as an adaptive function evolved to solve the challenges of cooperative life. Based on these assumptions, some theories argue that human morality is limited by the boundaries of group thinking, and always obeys the mandates of collective interests and the will of the majority. However, this conception has problematic implications from a normative and ethical perspective. The aim of Chapter 1 is to present this introductory debate in detail. In chapter 2, I consider a relevant amount of scientific evidence that helps to consolidate a more optimistic and inclusivist perspective about the starting conditions of human prosocial behavior. Later, I will summarize some ideas offered to explain the possible evolutionary mechanisms that led to the consolidation of these inclusivist capacities. However, I will also show how evolutionary theories that share the same adaptationist foundations but initially seem relevant to explain the feasibility of moral inclusivity, result incomplete when considering the complexity of moral behavior and its ethical implications. Part II is devoted to presenting a developmental alternative to the adaptationist versions around the starting conditions of morality. In this section, I first summarize the epistemological, conceptual, and empirical basis of a constructivist perspective already proposed by several authors in the last decades. This is the goal of chapter 3. More precisely, I adopt the conceptualization of morality established by the social-domain theory school and clarify its conception of the situated development of moral concerns, motivations, and norms. All these ideas are essential for my argumentation on the feasibility of inclusivist moral progress offered later. Chapter 4 provides a more detailed idea of constructivist thinking about moral development, by analyzing one particular dimension: the development of moral concerns for fairness and the sense of justice in distributive dilemmas. In Part III, I assume a constructivist perspective on morality to contribute to the philosophy of moral progress. In particular, I discuss the implications of such a perspective for the conceptualization of human moral nature and discuss what are the most favorable conditions for moral inclusivity to emerge. Answering that question is of enormous relevance since favoring the transition of human societies towards more inclusivist forms of moral concern and behavior supposes a more generalized accomplishment of our most urgent moral convictions. Previous developmental or culturally-sensible attempts to explore this issue are already on the market. As mentioned before, most authors have approached the topic by situating the cultural evolution and development of (inclusivist) moral progress in the WEIRD world. For instance, some of these authors claim that very concrete material conditions (mostly present in the Western World) have been necessary for triggering inclusivist and impersonal prosocial tendencies that human beings are not able to express in threatening contexts without physical security. Despite their interest in explaining inclusivist morality and the feasibility of inclusivist forms of progress following a naturalistic and culturally situated approach, these theories are problematic for two main reasons. In the first place, most of the authors that explain moral progress tend to focus exclusively on the consolidation of liberal values in the Western world and the underlying adoption of laws, social-epistemic practices, and public narratives about tolerance and inclusivity, as unequivocal signs of inclusivist morality. Nevertheless, there is an enormous distance between the institutional and public support of inclusivist moral values or the construction of public images of tolerance and inclusivity, and the real materialization of impersonal moralities in situated social interactions. Secondly, the variability of human moral behavior is far bigger than most of the theories in moral psychology and moral progress tend to assume. Accordingly, inclusivist and exclusivist forms of morality may develop simultaneously in similar or divergent geographical and socio-ecological environments, including those with harsh conditions such as competition for scarce resources, potential intergroup conflict, and risks of disease transmission. In addition, harsh environmental conditions are usually present in almost all societies around the globe, and the presence of socio-ecological conditions such as physical security and prosperity, predominant in highly resourced populations, do not prevent the existence of exclusivist moral tendencies. My model explores a different perspective on the relationships between cultural, institutional, and historical factors, and the situated development of human morality. This supposes a clear distinction from previous approaches to the matter since it offers a different view on what we should do to pursue further instances of inclusivist social progress. In the fifth chapter, I first analyze the proposals of some defenders of the ‘dependency’ theory. The attention is focused on the ‘Evolutionary Developmental Model’ proposed by Buchanan and Powell (2018). Based on a critique of this approach, I will argue that to explain the evolution and development of human morality in its multiple manifestations, it is essential to put focus on social interactions. This also involves a different perspective on human-environment relations that in line with a constructivist worldview makes an innovative contribution to the philosophy of moral behavior and moral progress. Later, in the sixth chapter, I will define my alternative relational view of inclusivist morality and I will offer my view on how to establish favorable conditions that make inclusivist morality possible. Complementing the constructivist approach, my conception is based on the essential role of equality and individuality and on how moral inclusivity is favored if moral concerns do not develop driven by the accomplishment of group-centered, binding, and communitarian concerns and values. In brief, my relational model suggests that the accomplishment of moral inclusivity not only depends on the overall achievement of certain levels of physical security or economic prosperity. Instead, its development is favored by transforming the interactional contexts in which moral concerns towards autonomy and individuality emerge. In arguing so, I will need to start with a critique of contemporary situated and embodied approaches in ethics. Then, I will show how societies guided by the accomplishment of group-centered values of power, dominance, and relational inequality tend to express exclusivist moral behaviors, while individualistic societies tend to be more inclusivist. Starting from this diagnosis, my final attempt is then to reflect on which are the best conditions for the moral valuation of individuality to emerge and what we should do to promote the accomplishment of moral inclusivity at the societal level. (shrink)

Christopher Boorse’s Health care ethics: an introduction, Temple University Press, Philadelphia, pp 359–393, 1987; in Humber, Almeder, Totowa What is disease?, Humana Press, New York City, pp 1–134, 1997; J Med Philos, 39:683–724, 2014) Bio-Statistical Theory comprehends diseases in terms of departures from natural norms, which involve an objectively describable deviation from the proper physiological or psychological functioning of parts of the human organism. I argue that while recent revisions and additional considerations shield the BST from a number of (...) issues raised by critics, they give rise to significant new challenges. These are related to the attribution of epistemic authority, the possibility of multiple concepts in the authoritative literature, and the framing of BST as “philosophical explication.” The conclusion is that, in its current form, the BST is unable to provide a robust framework for a naturalist classification. (shrink)