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Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
Russo bielefed dec11
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Russo bielefed dec11

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  • 1. Causes and probabilities for health Federica Russo Center Leo Apostel, Free University Brussels Center for Reasoning, University of Kent
  • 2. OverviewMedical humanities and philosophy of scienceCauses for healthProbabilities for healthFor whom? For what? 2
  • 3. Medical HumanitiesPHIL SCI PERSPECTIVEON MEDICINE 3
  • 4. The ‘human’ study of medicineMedicine, experimental medicine, and the biological understanding of wellness and diseaseMedical humanities bring ‘Man’ into medicine Anthropological, psychological, sociological, philosophical understanding of wellness and disease 4
  • 5. Phil med moves beyond ethicsTraditional phil med is about ethicsFresh philosophical look at medicine: How do we know: epistemology and methodology of medical research What it is: metaphysics of the ‘objects’ of medicine 5
  • 6. Medical HumanitiesTYPICAL QUESTIONS IN PHIL MED 6
  • 7. Ethics questions, e.g.:Is it ethical to conduct research on stem cells?Should we accept euthanasia?Is it ethical to deliver web-based diagnoses online to patients?… 7
  • 8. Phil Sci questions, e.g.:What notion of cause is applicable to biomedical contexts?How to interpret probability in biomedical contexts?What procedures grant extrapolation from animal models to humans?… 8
  • 9. Medical HumanitiesEXAMPLES 9
  • 10. Do electromagnetic fields cause brain tumour?John lived 40 years close to an antenna tower. Did this cause him cancer?How much is the risk of developing CHD lowered if I quit smoking?Did the campaign in schools lower smoking rates? 10
  • 11. Causes for HealthGENERIC AND SINGLE CASE 11
  • 12. Medical knowledge and Personalised medicineMedical knowledge: Personalised medicine:Generic causal relations Single Case causal relations Are in principle repeatable Are tailored to the individual patient Are supposed to hold of the majority of the Make use of specific, unique population information about the patient Epidemiological studies plus lab results 12
  • 13. Causes for HealthLEVELS OF CAUSATION 13
  • 14. A chicken-egg question?No primacy of either levelMutual need of both levelsAn iterative process 14
  • 15. Probabilities for HealthGENERIC AND SINGLE CASE 15
  • 16. Different levels of causation, different interpretations of probabilityGeneric Heavy smokers have 10 times more chances to develop lung cancer Frequency of occurrence of disease in a given populationSingle Case John’s chances of recovery after operation are 80% Degree of belief in occurrence of a specific event 16
  • 17. Causes for HealthCAUSES AS DIFFERENCE-MAKERS 17
  • 18. What causes are, what causes doA virus causes infectionPenicillin cures infectionSocio-economic status influences access to healthcareSmoking restricts blood vessels Different ‘things’ can be causes What they all do is to make a difference to a condition of health or of disease 18
  • 19. Causes for HealthVARIATIONAL EPISTEMOLOGYAND METHODOLOGY 19
  • 20. Look at variations in order to …Find out causes of diseaseFind out causes of recoveryFind out regulatory mechanismsComparisons between groups Exposed / unexposed; healthy / illWhat makes conditions vary across groups / individuals 20
  • 21. Probabilities for HealthODDS AND RISKS 21
  • 22. Risks, Odds and Probabilities: Easy to computeRisks and odds compare proportions in groups n11 / n11 n12 p11 RR Factor Disease n21 / n21 n22 p21 Yes No Oddsexp n11 / n12 Exposed n11 n12OR p11 p12 Oddsun exp n21 / n22 Unexposed n21 n22 Odds P p21 p22 P ; Odds 1 Odds 1 P
  • 23. Risks, Odds, and Probabilities ‘explained’… a RR equal to 2.0 means that an unexposed person is twice as likely to have and adverse outcome as one who is not exposed … (Sistrom&Garvan 2004)… odds and probabilities are different ways of expressing the chance that an outcome may occur… (Sistrom&Garvan 2004)… the probability that a child with eczema will also have fever is estimated by the proportion 141/561 (25.1%) … (Bland & Altman 2000)
  • 24. Risks, Odds, and Probabilities explained‘unexposed person’, ‘child’ are statistical individuals individuals randomly sampled from the populationOdds and risks compare proportions in groups They have a generic interpretation The corresponding probabilities are generic tooThey are not directly applicable to the single-case To be applicable they need to be constrained by further single case knowledge 24
  • 25. FOR WHOM?LAYMENWhat do laymen understand:Out of doctor’s explanation?In self, web-based diagnoses?In 123&me genetic mapping?In Wiki Medicare? 25
  • 26. FOR WHOM?MEDICALPRACTITIONERSHow can a betterunderstandingof phil med issuesimprove medicalpractitioners’explanations? 26
  • 27. For What?FIGHT STATISTICAL HEGEMONY 27
  • 28. Evidence-based people claim they can get ‘medical causes’ out of statistics Not so sure, thoughA point about philosophy of scienceWhat information is conveyed by statisticsA point about communication of science 28
  • 29. For What?RECONCILE WESTERN ANDNON-WESTERN HEALINGS 29
  • 30. Compare, set up a dialogueWhat can Western medicine learn from other ways of healing? And vice-versa.Salvage expert knowledge in the era of evidence. After ethno-biology, ethno-medicine? 30
  • 31. To sum upA gentle introduction to phil med for non-philosophers (Hopefully!) Medical humanities, philsci in medicineCauses and probabilities for health For populations, for individuals Medical knowledge, diagnosisWhom is this philosophy good for? (Hopefully!) Laymen, medical practitioners 31

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