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Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Journal of Medicine and Philosophy Inc.)

In this article, I present a philosophical account of medical treatment. In support of this account, I offer a suggestive account of medical conditions. The account of medical treatment uses three desiderata to demarcate treatment from non-treatment. Namely, a treatment should: (1) be describable by features that enable it to be standardized and characterized as a discrete intervention, (2) target a specific medical condition, and (3) have the possibility of being effective. The account of medical conditions underlies the second desideratum and attempts to tie medical conditions closely to biological dysfunction, while also including some conditions for which biological dysfunction is absent or its presence uncertain. I offer a simple typology of treatments and show how the accounts are relevant to treatment effectiveness, disease, placebos, contested treatments, and treatment standardization., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

With its rise in popularity, work in the phenomenology of medicine has also attracted its fair share of criticism. One such criticism maintains that, since the phenomenology of medicine does nothing but describe the experience of illness, it offers nothing one cannot obtain more easily by deploying simpler qualitative research methods. Fredrik Svenaeus has pushed back against this charge, insisting that the phenomenology of medicine not only describes but also defines illness. Although I agree with Svenaeus's claim that the phenomenology of medicine does more than merely describe what it is like to be ill, once one acknowledges its more far-reaching theoretical aspirations, one sees that it faces an even more difficult set of objections. Taking a cue from recent work by Rebecca Kukla, Russell Powell, and Eric Scarffe, I argue that the phenomenology of medicine could answer these objections by developing an institutional definition of illness. This not only allows the phenomenology of medicine to answer its critics, but it does so in a way that preserves its major achievements and extends its reach within the philosophy of medicine., (© 2023. The Author(s).)

Advanced computational approaches in artificial intelligence, such as machine learning, have been increasingly applied in life sciences and healthcare to analyze large-scale complex biological data, such as microbiome data. In this chapter, we describe the experimental procedures for using microbiome-based machine learning models for phenotypic classification., (© 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

The status of risk factors and disease remains a disputed question in the theory and practice of medicine and healthcare, and so does the related question of delineating disease boundaries. I present a framework based on Bernard Lonergan's account of emergent probability for differentiating (1) generically distinct levels of systematic function within organisms and between organisms and their environments and (2) the methods of functional, genetic, and statistical investigation. I then argue on this basis that it is possible to understand disease in terms of biological or higher intra-level dysfunction, risk factors-including genetic risk factors-in terms of statistical inter-level conditioning of a given stage or developmental sequence of systematic functioning, and the empirical boundaries of disease in terms of the limits of both functional categorization (from an epistemic standpoint) and upper-level integration of lower-level processes and events (from an ontological standpoint)., (© The Author(s) 2022. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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 and Griffiths [J Med Philos 42(4):447-466, 2017], however, may bear the seeds for the revival of purely naturalist approach to health and disease. In this paper, I defend their idea of Biological Normativity against recent criticism by Schwartz [J Med Philos Forum Bioethics Philos Med 42(4):485-502, 2017] and hope to help it flower into a revival of naturalist approaches in the philosophy of medicine.

Human physiology is a complex, nonlinear, self-regulated system, in which multiple functional subsystems act within the whole body reactivity. Understanding of physiology and pathophysiology requires integration of both clinical and basic factual knowledge and regulatory homeodynamic concepts. Two integrative methods have been developed to improve understanding of disease processes and natural development. Their features are here shortly presented. Matrix led algorhythmic analysis and re-synthesis puts together patients' clinical data along with a broad academic knowledge which may be relevant to it. Graphic representation enables outlining a multiple interconnections among etiopathogenetic components within the human body. The etiopathogenetic clusters (EPCs) are crossing points, the integrative hubs of disease pathways. Multiple diseases of triggered by independent etiologies often converge to a common EPC, and thus contributing to natural networking of physiological processes in health and diseases. Contemporary biomedical sciences have been daily producing copious amounts of data whose participation in integrative physiology is yet to be explored within the whole body reactivity. Graphic representation and active composition of pathophysiological processes stimulates a synthetic reasoning as a subroutine intellectual habit, critically relevant to both physicians and biomedical researchers. Integrative pathophysiology facilitates anchoring of a whole body and local etiopathogenetic mechanisms. This may be of special importance in contemporary trends of the intensive compartmentalization in medicine.

The complexity of biological objects and the rapid change in their composition after sampling, the variety of compounds of different chemical nature, possessing oxidative and antioxidant properties, make the task of its estimating extremely nontrivial and important for food, nutrients and human health characterization. The paper discusses the use of potentiometry in determining integral antioxidant/oxidant activity mainly of biological fluids and human skin. The source of information is the electrode potential shift that occurs when the analyzed object is inserted in the solution of the mediator system or when the mediator system is exposed to human skin. The experimental approaches, protocols, calculations are described. A number of examples of antioxidant activity and oxidative stress estimation in medicine are presented. The works show lower levels of antioxidant activity (AOA) of plasma and blood serum in patients with cardiovascular diseases, obesity, and malignant neoplasms as compared with the healthy volunteers. It was found out that antioxidant activity of fertile men semen is higher than AOA of infertile patients. Using the method discussed have shown that in some infertile male patients antioxidant activity of semen has been accompanied by oxidant activity. It has been found, that antioxidant activity of skin increases after intake of ascorbic acid and vitamin-enriched juices. The described approach holds considerable promise for monitoring oxidative stress of the whole organism and its systems, and for selecting effective and safe therapy. Thus, it opens up new opportunities in expanding the use of analytical chemistry in such an important field as medicine.

The rising costs of health care in the United States continue to stimulate interest in alternative health care options among Americans. Western medicine is also beginning to pay more attention to these alternative practices and their utility for successful treatment of illness. Alternative health care practices have always been used by Hispanics whose mortality and morbidity profiles have stimulated interest from researchers. Though Hispanics occupy some of the lowest socioeconomic positions in the United States, they have higher life expectancy rates and comparable rates of morbidity for many health conditions relative to other racial/ethnic groups. This has been referred to as the "Hispanic health advantage" and the "Hispanic health paradox" [Turra CM, Elo IT. The impact of salmon bias on hispanic mortality advantage: new evidence from social security data. Popul Res Policy Rev. 2008;27:515. Franzini L, Fernandez-Esquer ME. Socioeconomic, cultural, and personal influences on health outcomes in low income Mexican-origin individuals in Texas. Soc Sci Med. 2004;59(8):1629-1646. George M. The Mexican-American health paradox: the collective influence of sociocultural factors on Hispanic health outcomes., Discussions: 2013;9(2):2-3. Gallo LC, Penedo FJ, Espinosa de los Monteros K, Argueles W. Resiliency in the face of disadvantage: do hispanic cultural characteristics protect health outcomes. J Pers. 2009;77(6):1707-1746. Turra CM, Goldman N. Socioeconomic differences in mortality among U.S. adults: insights into the Hispanic paradox. J Gerontol. 2007;62(3):184-192]. Even when controlling for socioeconomic status and education, life expectancy for Hispanics is greater than that of whites (CDIC, 2015). Debate about the causes of this paradox continues and some data indicates that the paradox is specific to older Hispanics (i.e., middle and older ages). Among Hispanic ethnic groups, this "paradox" has been most salient for Mexican Americans, therefore, this chapter focuses on Mexican Americans and the intersections of traditional health care practices among Mexican Americans (curandismo) with the practice of Western medicine to explore how they combine and conflict to impact aging Hispanics in three health areas: diabetes, menopause, and dementia., (Copyright © 2017. Published by Elsevier Inc.)

The human organism presents a complex biological system that has hierarchical organization. The lowest, basal hierarchical level is composed of chemical molecules. The system's structure as "the whole" is maintained by complex interactions of its parts (molecules). New forms and functions, not present in molecules themselves emerge from their orchestrated and coordinated interaction, creating the novel "whole". The "whole" is not a simple summation of its parts. Therefore, on the basis of reductionist analysis and solely on the list of component elements of biological systems it is not possible to predict the future form and function of the "whole". The information included in genes is not directly or proportionally expressed as the phenotype. The phenotype is based on secondary information and arises from the complex interaction of component elements of the system. On a basal (molecular) level, biological systems function according to self-organization rules. No central regulatory device is providing instruction for molecular interaction. Regulatory centers that coordinate the system are dispersed all over the system from molecular level up, keeping it in order and preventing a system to enter the chaos space. Advances in biology and development of new research technologies, as well as bioinformatics, computer sciences and mathematical modeling have enabled research on interaction of cellular macromolecules (proteins, DNA, RNA, etc.) that in a living cell are organized into large dynamic network. Some rules of a structural and functional networks' properties, as well as their organization were discovered. The above research area is regarded as a new academic field termed systems biology. Based on systems biology, many new concepts in medicine, particularly the mechanisms of biogenesis and development of diseases have emerged have potential application for early diagnostics and therapy.

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., (© The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We introduce the field of Hamiltonian medicine, which centres on the roles of genetic relatedness in human health and disease. Hamiltonian medicine represents the application of basic social-evolution theory, for interactions involving kinship, to core issues in medicine such as pathogens, cancer, optimal growth and mental illness. It encompasses three domains, which involve conflict and cooperation between: (i) microbes or cancer cells, within humans, (ii) genes expressed in humans, (iii) human individuals. A set of six core principles, based on these domains and their interfaces, serves to conceptually organize the field, and contextualize illustrative examples. The primary usefulness of Hamiltonian medicine is that, like Darwinian medicine more generally, it provides novel insights into what data will be productive to collect, to address important clinical and public health problems. Our synthesis of this nascent field is intended predominantly for evolutionary and behavioural biologists who aspire to address questions directly relevant to human health and disease.

Background: Assessment and management of symptoms is a main task in primary care. Symptoms may be defined as 'any subjective evidence of a health problem as perceived by the patient'. In other words, symptoms do not appear as such; symptoms are rather the result of an interpretation process. We aim to discuss different perspectives on symptom interpretation as presented in the disciplines of biomedicine, psychology and anthropology and the possible implications for our understanding of research on symptoms in relation to prevalence and diagnosis in the general population and in primary care., Discussion: Symptom experiences are embedded in a complex interplay between biological, psychological and cultural factors. From a biomedical perspective, symptoms are seen as possible indicators of disease and are characterized by parameters related to seriousness (e.g. appearance, severity, impact and temporal aspects). However, such symptom characteristics are rarely unambiguous, but merely indicate disease probability. In addition, the GP's interpretation of presenting symptoms will also be influenced by other factors. From a psychological perspective, factors affecting interpretation are in focus (e.g. internal frame of reference, attention to sensations, illness perception and susceptibility to suggestion). These individual factors cannot stand alone either, but are influenced by the surroundings. Anthropological research suggests that personal experiences and culture form a continuous feedback relationship which influence when and how sensations are understood as symptoms of disease and acted upon., Summary: The different approaches to symptom interpretation imply that we need to be cautious and conscious when interpreting survey findings that are based on symptom prevalence in the general population or in primary care. These findings will reflect a variety of interpretations of sensations, which are not equivalent to expressions of underlying disease. Furthermore, if diagnosis of disease is based exclusively on the presence of specific symptom characteristics, we may risk reinforcing a dualistic approach, including medicalisation of normal phenomena and devaluation of medically unexplained symptoms. Future research in primary care could gain from exploring symptoms as a generic phenomenon and raised awareness of symptom complexity.

The Commentary of Mills and Sykes in Science Translational Medicine presented their thesis on the advent of high-throughput technologies and the dangers they may represent for the future of biomedical research. In response, we argue that true progress on the diagnosis and treatment of common human diseases will require the advent of big biology and its deep integration with focused research as practiced in both academic and industrial institutions.

The following report selects and summarises some of the conclusions and recommendations generated throughout a series of workshops and discussions that have lead to the publication of the Science Policy Briefing (SPB) Nr. 35, published by the European Science Foundation. (Large parts of the present text are directly based on the ESF SPB. Detailed recommendations with regard to specific application areas are not given here but can be found in the SPB. Issues related to mathematical modelling, including training and the need for an infrastructure supporting modelling are discussed in greater detail in the present text.)The numerous reports and publications about the advances within the rapidly growing field of systems biology have led to a plethora of alternative definitions for key concepts. Here, with 'mathematical modelling' the authors refer to the modelling and simulation of subcellular, cellular and macro-scale phenomena, using primarily methods from dynamical systems theory. The aim of such models is encoding and testing hypotheses about mechanisms underlying the functioning of cells. Typical examples are models for molecular networks, where the behaviour of cells is expressed in terms of quantitative changes in the levels of transcripts and gene products. Bioinformatics provides essential complementary tools, including procedures for pattern recognition, machine learning, statistical modelling (testing for differences, searching for associations and correlations) and secondary data extracted from databases.Dynamical systems theory is the natural language to investigate complex biological systems demonstrating nonlinear spatio-temporal behaviour. However, the generation of experimental data suitable to parameterise, calibrate and validate such models is often time consuming and expensive or not even possible with the technology available today. In our report, we use the term 'computational model' when mathematical models are complemented with information generated from bioinformatics resources. Hence, 'the model' is, in reality, an integrated collection of data and models from various (possibly heterogeneous) sources. The present report focuses on a selection of topics, which were identified as appropriate case studies for medical systems biology, and adopts a particular perspective which the authors consider important. We strongly believe that mathematical modelling represents a natural language with which to integrate data at various levels and, in doing so, to provide insight into complex diseases: 1. Modelling necessitates the statement of explicit hypotheses, a process which often enhances comprehension of the biological system and can uncover critical points where understanding is lacking. 2. Simulations can reveal hidden patterns and/or counter-intuitive mechanisms in complex systems. 3. Theoretical thinking and mathematical modelling constitute powerful tools to integrate and make sense of the biological and clinical information being generated and, more importantly, to generate new hypotheses that can then be tested in the laboratory.Medical Systems Biology projects carried out recently across Europe have revealed a need for action: 4. While the need for mathematical modelling and interdisciplinary collaborations is becoming widely recognised in the biological sciences, with substantial implications for the training and research funding mechanisms within this area, the medical sciences have yet to follow this lead. 5. To achieve major breakthroughs in Medical Systems Biology, existing academic funding schemes for large-scale projects need to be reconsidered. 6. The hesitant stance of the pharmaceutical industry towards major investment in systems biology research has to be addressed. 7. Leading medical journals should be encouraged to promote mathematical modelling.

Aims: The aim of this paper is to review the literature concerning the existence of prestige hierarchies for medical specialities and diseases. Moreover, the implications of prestige for priority setting in healthcare systems are discussed., Methods: The study is based on a review of the literature. Papers were obtained through the National Library of Medicine, PubMed. The search was conducted on 14 July 2005, and included articles from 1950 until that date. The medical subject headings "disease", "illness", and "medical specialities" were combined with the search word "prestige". A total of 183 papers were found. Only studies focusing on prestige hierarchies for medical specialities and diseases were included. The final search identified 20 articles, six of which specifically established hierarchies for medical specialities and diseases., Results: The review documented prestige hierarchies for medical specialities and diseases. Explanatory characteristics behind the distribution of prestige were identified. It was demonstrated that active, specialized, biomedical, and high-technological types of medicine practised on organs in the upper part of the bodies of young or middle-aged people were accorded high levels of prestige. Medicine with the opposite characteristics had low levels of prestige., Conclusions: Medical specialities and diseases differ with regard to prestige. Characteristics related to specialties and diseases determine their prestige. The authors suggest that differences in prestige bear consequences for actual priority setting in healthcare systems, and contend that this should be further investigated.

Thomas Lindley, an English businessman , was arrested for smuggling in Bahia at the beginning of the nineteenth century. He was mistaken gor a doctor and ended up serving as one while there. Upon returning to England, he published his diary. This study takes a close look at this references to how settlers back then and there experienced disease and medical treatment.

Apoptosis is a kind of cell death essential for normal functioning and survival of most multicellular organisms. Apoptosis plays an important role in physiological processes and in pathophysiology of some chronic diseases, including autoimmunity, cancer, lymphoma, AIDS, neurodegeneration and others. The present paper describes the interdisciplinary pathogenesis of programmed cell death, the mechanisms inducing apoptosis and the role of apoptosis in some physiological phenomena and in medical practice.

The author focuses on how medicine, pharmacy and health care evolved in Curaçao (The Netherlands Antilles) in the last 40 years. By relating the global history of medicine he describes the introduction and influence of medicine, pharmacy and medical theories on the island. He also looks at the illnesses that manifested themselves there and gives statistics of life expectancy and population growth.

The essay II, 37 De la ressemblance des enfants aux pères, written by Montaigne between 1579 and the first months of 1580, is a merciless critique of doctors, doctoring and medicine in general. This Essay, as much as a large number of other texts, of archival records, of iconographic materials produced during the Early Modern period, testifies a wide spread skeptical attitude toward medicine across Europe. This is an important aspect of Early Modern culture. Despite its relevance it has been often neglected by medical historians. This paper aims to show how a literary text can contribute to the understanding of the rise of some aspects of these critical attitudes towards medicine and medics. In Montaigne's text, these attitudes appear to be generated by his personal experiences of suffering and disillusion deeply entangled with a long tradition of philosophical skepticism to which some of his favorite readings belong. Both these elements seem to have also contributed to bring Montaigne in 1580 to the definition of the poetic project of the Essays as a self-portrait: a project in which the bodily presence of the author, with his humors, passions and sufferings, is self-consciously part of the writing process and of the intellectual enterprise.

The article examines medieval medicine from the point of view of the daily lives of the citizens of Wrocław. The author describes the conditions of daily life, in other words living conditions, personal hygiene, food and surroundings, often influenced by fundamental calamities, the climate, and medieval ideology, among which one can include asceticism, astrology, alchemy, magic and superstition, factors which affected the health of the medieval population. Next, she discusses methods of combating common illnesses, especially infections, in other worlds medieval preventive medicine and therapy, as well as the training and work of physicians and the development of medieval medical science in Silesia.

Research in the works of the Byzantine medical authors brought to light significant information concerning disorders of the sperm as causes of infertility. The eminent Byzantine physicians give detailed accounts about the anatomy of the genitals, the creation of the sperm and its disorders as regards its quantity, quality, appearance, consistency, colour, ejaculation etc. According to those authors, the disorders of the sperm are due to, dietetic reasons (a list of foods and drugs influencing the production of sperm is referred to by many Byzantine physicians); constitution and age of the patient; obesity; diseases, such as "gonorrhea" (involuntary loss of sperm), oneirogmus, stenosis of the spermiducts, hypospadias and atrophy of the genitals; iatrogenic reasons (traumatic cutting off of the spermiducts during a lithotomy); castration. These concepts were based on the works of the ancient Greek physicians of the Hippocratic, Hellenistic and Roman eras. However, such ideas, enriched by the personal experience of the Byzantine doctors, were transmitted to and influenced Islamic and European medicine and thus the rest of the world.

This introductory paper has two main themes: first, what can be said about the diseases characteristic of the period in question; second, what generalizations are possible about the medicine that could be deployed against them. After a preliminary discussion of the extent to which the system of dating from Christ's incarnation governed the chronology of those who fall within our scope, the paper raises the question of whether the year 1000 prompted millenial 'fever'. This leads into an account of the concept of 'pathocoenosis', a tableau of the interrelated diseases prevalent at any one place and time. The limitations of the tenth- to eleventh-century evidence available for such a project are examined, philosophical objections to disease history reviewed, and agenda for future research outlined. The paper then turns to the main features of the medical texts on which any investigation of therapeutic practice in the early Middle Ages must depend: features such as amorphousness, mutability, lack of theory, elusive connection with clinical reality. Finally, some wider implications of the special issue are delineated-concerning presumed contrasts between East and West, and, with respect to the relationship of theory to practice, between early and later Middle Ages.

What patients believe about time has much to do with their notion of health and medicine. Synchrony of time sense between physician and patient shapes the objectives and the content of care and compliance; asynchrony leads to frustration and failure. Traditional time is circular, a regular repetition of events and ideas. Traditional time is driven by the environment in that planets, stars, and spirits appear to control the cycles of nature. There is no apocalypse, no salvation or damnation; rather, there is a continuous cycle of reincarnation that can be stopped or escaped only by extraordinary action. Traditional time leads to a static, stable world. In this view, changes are transient because things that were will be again; progress is fiction, a conceit of the proud. Renaissance notions of the perfectibility of humankind, the importance of individuality, and the possibility of progress originated with a sense of time as a straight line leading to "an end of time" and apocalypse, rather than a circle. The present Christian calendar is the product of 16th-century attempts to unify the calendrical expectations for the apocalypse held by diverse Christian sects and to rectify the discrepancies between the old calendar timing of Christian holy days and the natural seasonal cycles. Millenarian and scientific time have a future; traditional time is, in a sense, timeless.

John Locke engaged in a systematic study of medicine from the late 1650's. In this period he acquainted himself with the three main competing natural philosophical theories of the time -Galenism, Paracelsianism and Mechanism. He was particularly interested in the work of Sennert, Helmont and Doyle. In 1666, just after the publication of Boyle's The Origine of Formes and Qualities, Locke wrote a short paper entitled Morbus. This paper gave Locke's own view of the nature of disease. Locke went out of his way to criticise Boyle's attempts to give mechanical explanations for biological phenomena. He endorsed Helmont's theory that disease was caused by "ferments" and "Archei" and re-introduced Galenic temperaments as factors of susceptibility in seminal diseases. Locke did not endorse a mechanical corpuscularianism at this stage in his career, when his contact with Boyle was most frequent. Consequently, Locke's espousal of the corpuscular philosophy in the Essay cannot be attributed to Locke's association with Boyle at this time.