Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop (...) a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

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When faced with an urgent and credible threat of grave harm, we should take proportionate precautions. But what is it for a precaution to be “proportionate”? I construct a pragmatic analysis of consisting of four tests—permissibility-in-principle, adequacy, reasonable necessity and consistency—that could realistically be applied by a citizens’ assembly meeting online or in person. I apply these tests retrospectively to two examples from the COVID-19 pandemic—border closures and school closures—arguing that my account captures the key questions on which it is (...) both feasible and important to integrate expert input with democratic input. I then consider how we might try to manage the risk of future pandemics in a proportionate way. (shrink)

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What can we, as a society, legitimately expect from science? And what, if anything, can science legitimately expect from society? This paper argues that the relationship between science and society is governed by a science contract. I first introduce the notion of an expertise contract—a social contract that governs the relationship between experts and non-experts, bestows on experts certain fiduciary duties towards non-experts, and enables the division of epistemic labor in society. I then argue that the science contract cannot be (...) simply identified with the expertise contract as it applies to scientific experts but requires at least two modifications in order to reflect the global nature of science and the role of scientists as researchers. I conclude with some remarks about public trust in science and a non-ideal theory of the scientific contract. (shrink)

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The last couple of decades have witnessed a renewed interest in the notion of inductive risk among philosophers of science. However, while it is possible to find a number of suggestions about the mitigation of inductive risk in the literature, so far these suggestions have been mostly relegated to vague marginal remarks. This paper aims to lay the groundwork for a more systematic discussion of the mitigation of inductive risk. In particular, I consider two approaches to the mitigation of inductive (...) risk—the individualistic approach, which maintains that individual scientists are primarily responsible for the mitigation of inductive risk, and the socialized approach, according to which the responsibility for the mitigation of inductive risk should be more broadly distributed across the scientific community or, even more broadly, across society. I review some of the argument for and against the two approaches and introduce two new problems for the individualistic approach, which I call the problem of precautionary cascades and the problem of exogenous inductive risk, and I argue that a socialized approach might alleviate each of these problems. (shrink)

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Should we say 'a little bit of cancer'? Many argue that we should avoid the phrase and instead relabel early cancers as a strategy to prevent overtreatment. Against this, I argue that we should not shy away from saying 'a little bit of cancer', and, moreover, that shying away misses a key opportunity to address the problem of overtreatment. Drawing on speech act theory, I examine the diagnosis of cancer as illocutionary speech act and argue for a revisionist strategy which (...) seeks to shift the normative force of the cancer diagnosis qua speech act. I show how this strategy offers distinct advantages vis-à-vis alternative approaches to tackling the problem of overtreatment. (shrink)

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This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and (...) evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)

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Some patients, following brain injury, do not outwardly respond to spoken commands, yet show patterns of brain activity that indicate responsiveness. This is “cognitive-motor dissociation” (CMD). Recent research has used machine learning to diagnose CMD from electroencephalogram (EEG) recordings. These techniques have high false discovery rates, raising a serious problem of inductive risk. It is no solution to communicate the false discovery rates directly to the patient’s family, because this information may confuse, alarm and mislead. Instead, we need a procedure (...) for generating case-specific probabilistic assessments that can be communicated clearly. This article constructs a possible procedure with three key elements: (1) a shift from categorical “responding or not” assessments to degrees of evidence; (2) the use of patient-centred priors to convert degrees of evidence to probabilistic assessments; and (3) the use of standardized probability yardsticks to convey those assessments as clearly as possible. (shrink)

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Establishing the effectiveness of medical treatments is one of the most important aspects of medical practice. Bradford Hill's viewpoints play an important role in inferring causality in medicine,...

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Cancer—and scientific research on cancer—raises a variety of compelling philosophical questions. This entry will focus on four topics, which philosophers of science have begun to explore and debate. First, scientific classifications of cancer have as yet failed to yield a unified taxonomy. There is a diversity of classificatory schemes for cancer, and while some are hierarchical, others appear to be “cross-cutting,” or non-nested. This literature thus raises a variety of questions about the nature of the disease and disease classification. Second, (...) philosophers of science have historically taken the aim of science to be arriving at true theories. However, scientists studying cancer come from a variety of disciplines, with different scientific as well as practical aims. Perhaps it is not surprising, then, that historians and philosophers of science do not seem to agree on how best to characterize the aim and structure of cancer research; it is far from clear whether the appropriate characterization of the aim is arriving at true theories, or even whether the proper units of analysis are “theories”, or instead, “models”, “explanatory frameworks”, “research programs”, “paradigms”, or perhaps, “experimental traditions”. With the rise of “big data” science—such as the Cancer Genome Atlas Project (or TCGA)—and “systems” approaches to the study of disease, both philosophers and historians of science are rethinking how best to describe and explain these distinctive kinds of scientific inquiry. -/- Third, cancer is in part a byproduct of our developmental and life history, as well as our evolutionary history. Cancer progression can be compared to a reversion of development, or, to the evolution of multicellularity. Thus, cancer raises intriguing questions about how we conceive of “functions”, “development”, and the role of our evolutionary history and particularly, selective trade-offs, in vulnerability to disease. -/- Last but not least, cancer research provides a case study for consideration of the roles of values at the science-policy interface. Epidemiological and toxicological research on cancer’s causes informs toxics law and regulatory policy, which raises a variety of questions about the nature of evidence and inductive risk in such contexts. (shrink)

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This paper has two goals. The first is to fill a gap in the literature on inductive risk by exploring the relevance of the notion of inductive risk to macroeconomics and monetary policy. The second goal is to draw some general lessons about inductive risk from the case discussed. The most important of these lessons is that the notion of inductive risk is no less relevant to the relationship between the proximate and distal goals of policy than it is to (...) the relationship between policies and their goals. (shrink)

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