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Decision and Discovery in Defining “Disease”

In Harold Kincaid & Jennifer McKitrick (eds.), Establishing medical reality: Methodological and metaphysical issues in philosophy of medicine. Springer Publishing Company. pp. 47-63 (2007)

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  1. Small Tumors as Risk Factors not Disease.Peter H. Schwartz - 2014 - Philosophy of Science 81 (5):986-998.
    I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based (...)
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  • Reframing the Disease Debate and Defending the Biostatistical Theory.Peter H. Schwartz - 2014 - Journal of Medicine and Philosophy 39 (6):572-589.
    Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...)
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  • Disease, Dysfunction, and Synthetic Biology.Sune Holm - 2014 - Journal of Medicine and Philosophy 39 (4):329-345.
    Theorists analyzing the concept of disease on the basis of the notion of dysfunction consider disease to be dysfunction requiring. More specifically, dysfunction-requiring theories of disease claim that for an individual to be diseased certain biological facts about it must be the case. Disease is not wholly a matter of evaluative attitudes. In this paper, I consider the dysfunction-requiring component of Wakefield’s hybrid account of disease in light of the artifactual organisms envisioned by current research in synthetic biology. In particular, (...)
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  • Public health.Dean Rickles - 2011 - In Fred Gifford (ed.), Philosophy of Medicine. Boston: Elsevier.
    Public health involves the application of a wide variety of scientific and non-scientific disciplines to the very practical problems of improving population health and preventing disease. Public health has received surprisingly little attention from philosophers of science. In this chapter we consider some neglected but important philosophical aspects of the science of public health.
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  • Defining dysfunction: Natural selection, design, and drawing a line.Peter H. Schwartz - 2007 - Philosophy of Science 74 (3):364-385.
    Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds on the (...)
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  • What is Mental Health and Disorder? Philosophical Implications from Lay Judgments.Somogy Varga & Andrew J. Latham - 2024 - Synthese (5).
    How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). While we find that (...)
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  • Wherein is the concept of disease normative? From weak normativity to value-conscious naturalism.M. Cristina Amoretti & Elisabetta Lalumera - 2021 - Medicine, Health Care and Philosophy 25 (1):1-14.
    In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...)
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  • Philosophy of Psychiatry.Jonathan Y. Tsou - 2021 - Cambridge: Cambridge University Press.
    Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity of the DSM's (...)
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  • Biological normativity: a new hope for naturalism?Walter Veit - 2021 - Medicine, Health Care and Philosophy 24 (2):291-301.
    Since Boorse [Philos Sci 44(4):542–573, 1977] published his paper “Health as a theoretical concept” one of the most lively debates within philosophy of medicine has been on the question of whether health and disease are in some sense ‘objective’ and ‘value-free’ or ‘subjective’ and ‘value-laden’. Due to the apparent ‘failure’ of pure naturalist, constructivist, or normativist accounts, much in the recent literature has appealed to more conciliatory approaches or so-called ‘hybrid accounts’ of health and disease. A recent paper by Matthewson (...)
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  • A New Approach to Defining Disease.Mary Jean Walker & Wendy A. Rogers - 2018 - Journal of Medicine and Philosophy 43 (4):402-420.
    In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...)
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  • Truth or Spin? Disease Definition in Cancer Screening.Lynette Reid - 2017 - Journal of Medicine and Philosophy 42 (4):385-404.
    Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; (...)
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  • (1 other version)Defining disease in the context of overdiagnosis.Mary Jean Walker & Wendy Rogers - 2017 - Medicine, Health Care and Philosophy 20 (2):269-280.
    Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...)
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  • Ni vivo ni muerto, sino todo lo contrario. Reflexiones sobre la muerte cerebral.David Rodríguez-Arias - 2013 - Arbor 189 (763):a067.
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  • Naturalism in Philosophy of Health: Issues and Implications.Élodie Giroux (ed.) - 2016 - Cham: Springer.
    In a series of papers published in the 1970s, Christopher Boorse proposed a naturalist theory of health, mainly based on a value-free concept of ‘biological function’, a concept of ‘reference class’ and the notion of ‘statistical normality’. His theory has profoundly shaped the philosophical debates on the concepts of health and disease. It could even be said that the numerous criticisms of his 'biostatistical theory' are at the centre of what is usually referred to as the debate between ‘normativists’ and (...)
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  • Nosological Diagnosis, Theories of Categorization, and Argumentations by Analogy.Francesco Gagliardi - 2022 - Journal of Medicine and Philosophy 47 (2):311-330.
    The nosological diagnosis is a particular type of nontheoretical diagnosis consisting of identifying the disease that afflicts the patient without explaining the underlying etiopathological mechanisms. Its origins are within the essentialist point of view on the nature of diseases, which dates back at least to 18th-century taxonomy studies. In this article, we propose a model of nosological diagnosis as a two-phase process composed of the categorization of inductive inferences and argumentations by analogy. In the inductive phase, disease entities are identified (...)
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  • Can aging research generate a theory of health?Jonathan Sholl - 2021 - History and Philosophy of the Life Sciences 43 (2):1-26.
    While aging research and policy aim to promote ‘health’ at all ages, there remains no convincing explanation of what this ‘health’ is. In this paper, I investigate whether we can find, implicit within the sciences of aging, a way to know what health is and how to measure it, i.e. a theory of health. To answer this, I start from scientific descriptions of aging and its modulators and then try to develop some generalizations about ‘health’ implicit within this research. After (...)
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  • The concept of disease in the time of COVID-19.Maria Cristina Amoretti & Elisabetta Lalumera - 2020 - Theoretical Medicine and Bioethics 41 (5):203-221.
    Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and (...)
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  • Epistemic Authority, Philosophical Explication, and the Bio-Statistical Theory of Disease.Somogy Varga - 2020 - Erkenntnis 85 (4):937-956.
    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 (...)
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  • Introduction: The Boundaries of Disease.Mary Jean Walker & Wendy A. Rogers - 2017 - Journal of Medicine and Philosophy 42 (4):343-349.
    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; (...)
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  • Progress in Defining Disease: Improved Approaches and Increased Impact.Peter H. Schwartz - 2017 - Journal of Medicine and Philosophy 42 (4):485-502.
    In a series of recent papers, I have made three arguments about how to define “disease” and evaluate and apply possible definitions. First, I have argued that definitions should not be seen as traditional conceptual analyses, but instead as proposals about how to define and use the term “disease” in the future. Second, I have pointed out and attempted to address a challenge for dysfunction-requiring accounts of disease that I call the “line-drawing” problem: distinguishing between low-normal functioning and dysfunctioning. Finally, (...)
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  • Health as a Property of Engineered Living Systems.Sune Holm - 2013 - Bioethics 27 (8):419-425.
    This article considers naturalistic analyses of the concepts of health and disease in light of the possibility of constructing novel living systems. The article begins by introducing the vision of synthetic biology as the application of engineering principles to the construction of biological systems, the main analyses of the concepts of health and disease, and the standard theories of function in artefacts and organisms. The article then suggests that reflection on the possibility of artefactual organisms amounts to a challenge to (...)
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  • Do health professionals have a prototype concept of disease? The answer is no.Bjørn Hofmann - 2017 - Philosophy, Ethics, and Humanities in Medicine 2017 12:1 12 (1):6.
    Health and disease are core concepts in health care and have attracted substantial interest and controversy. In recent and interesting contributions to the debate it has been argued that the challenges with the concept of disease can be resolved by a prototype concept of disease. As a robin is a more prototypical of a bird than a penguin, some diseases are more prototypical than others. If disease is a prototype concept, it would change nosology, but also health care and the (...)
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  • How to Proceed in the Disease Concept Debate? A Pragmatic Approach.Leen De Vreese - 2017 - Journal of Medicine and Philosophy 42 (4):424-446.
    In the traditional philosophical debate over different conceptual analyses of “disease,” it is often presupposed that “disease” is univocally definable and that there are clear boundaries which distinguish this univocal category “disease” from the category of “nondisease.” In this paper, I will argue for a shift in the discussion on the concept of “disease” and propose an alternative, pragmatic approach that is based on the conviction that “disease” is not a theoretical concept but a practical term. I develop a view (...)
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  • Clarifying the concept of disease: how science determines the biologically normal from the abnormal.Loren Zech - 2011 - Dissertation, University of Illinois at Urbana-Champaign
    This is an investigation of the modern concept of disease and an explication of the concept consistent with scientific and medical usage. The core notion involved in the modern concept of disease (taken broadly as pathology) is biological abnormality in form or function, for a circumscribed biological system, contrasted against a theoretical sense of normal form or function. Chapter 2 presents an overview of science, its products and how these are produced. This sketch is limited and intended only to clarify (...)
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