Institut d’Histoire et de Philosophie des Sciences et des Techniques (IHPST) - Paris

1. Socio-markers and
information transmission
Federica Russo
Philosophy & ILLC | University of Amsterdam
Science and Technology Studies | University College London
russofederica.wordpress.com |@federicarusso

2. Outline
• Bio- and socio-markers
• What are they?
• Markers in bio-social mechanisms
• What should we mark, exactly?
• Towards a processual understanding of health and disease
• Causation as information transmission
• Using bio- and socio-markers
• Where is the thin line between a good and bad use?
2

3. Bio-markers and the molecular
turn in epidemiology
3

4. Marking bio-chemical processes
• There isn’t just one definition of bio-markers, but usually they share some common points
• Bio-markers point to bio-chemical characteristics
• These characteristics are measurable somehow (e.g. with –omics)
• These measurements should give insights into normal/pathogenic process
• The purposes of measurement may be different (e.g. diagnosis, monitoring, prediction)
4

5. The promise of bio-markers
• Establish a link between exposure and clinical outcomes
• Gain understanding of normal/pathological processes
• Improve on early prediction of clinical outcomes
• …
5

6. Not entities but markers
of various kind of processes
“Does the marker represent an event, is it an event itself, is it a correlate of the event, or is it a
predictor of the event?
The answers to these questions may affect who is sampled, how and when they are sampled, and
what confounders or effect modifiers are considered. […]
Thus, a biologic marker often refers to the use made of a piece of biologic information rather than
to a specific type of information.”
Schulte, 1993, p.14-15.
6
A metaphysical question with
methodological considerations

7. Bio-markers are not (always) causes
7
X Y
B
X Y
B
X Y
B
Z
B Y
X
Biomarker B is part of the causal
process linking the cause X and
the effect Y
biomarker B and the effect Y are
correlated because both are
caused by X
Biomarker B is correlated with an
event Z, that is part of the process
from X to Y
Biomarker is correlated with X,
not causally linked to the effect Y;
B may be a background condition

8. Over-biologizing
health and disease?
Markers in bio-social mechanisms
8

9. The mixed bio-social nature
of health and disease
• Established and vast research traditions
• The bio-chemistry of health and disease
• The social nature and effects of health and disease
• How to combine them?
• Not just social determinants, distant causes, or ‘causes of causes’
• Social factors are active, proximate causes in bio-social mechanisms
9

10. Easier said than done
• Some research in this direction exists (e.g. Lifepath project)
• But it needs further conceptualization and methodological tools
10

11. The social determinants approach
• Socio-economic factors (and inequalities) map onto health patterning
at societal level
• Social epidemiology
• Quantitative sociology of health
• It establishes that social factors are linked to health, not how-why
11

12. Markers or determinants?
• WHO defines social determinants as
• “[…] non-medical factors that influence health outcomes. They are the
conditions in which people are born, grow, work, live, and age, and the
wider set of forces and systems shaping the conditions of daily life. These
forces and systems include economic policies and systems, development
agendas, social norms, social policies and political systems.”
• Potential role in addressing inequalities
• But, (unintended) deterministic baggage?
• A useful definition with a less useful definiendum?
12

13. Markers vs determinants
Similarities
• Both markers and determinants
• are measurable
• refer to social characteristics of
individuals
• Broadly including economic, social,
cultural, or other factors
• are individual level but possible to
aggregate
• can be used to prospectively
predict and retrospectively explain
Dissimilarities
Markers, instead:
• need to be of greater range and
granularity
• indicate, rather than determine,
a state of a process
• can point to proximate, rather
than distant, processes
• are not classificatory factors
13

14. Marking social processes
• From exposure science: identify and validate markers of biological processes
• From social science research: identify and validate markers of relevant social processes
• Use individual-level socio-economic variables as markers of long term bio-social mechanisms
• Analogy with biomarkers: find markers of social processes that intersect, interact, influence, shape
health and disease
• Prospectively predict or retrospectively explain health and social outcomes
• Socio-markers provide information of ‘key characteristics’ of bio-social mechanisms
• Typical social science indicators: educational level, occupational class, income
• But we also need to:
• Increase the range of relevant indicators (How? Hint: mixed methods, complexity approaches)
• Use socio-markers to trace active causes, not just the proxies
14

15. Markers of processes
• Towards process-based disease causation
• Bio- and socio-markers are not causes, in the sense of entities that cause
normal of pathogenic processes
• Bio- and socio-markers mark salient points of a process (normal or
pathological) to be understood in causal terms
• Disease causation as information transmission
• Bio- and socio-markers help us track the flow of information from exposure to
clinical outcome
• Bio-social mechanisms are the ‘channels’ in which the information flow, they
are epistemic boundaries in which we look for these markers
15

16. Markers of salient points of the process
• The goal is not to have a full description of bio-social mechanisms
• But to identify key points
• See ‘Key characteristics of carcinogenesis’
• In line with Evidential Pluralism
• A metaphysical shift:
• ‘Process’ is the basic ontological unit
• ‘Bio-social mechanism’ gives the epistemic boundaries within which we intend to study the process
• ‘Bio- and socio-markers’ signpost the key points of the trajectory, from exposure to clinical outcome
16

17. life experiences across
soc-bio factors, starts
early in life,
Individual and
community level
From causal factors to causal processes
• A conceptual shift: emphasis on causal processes that biological and
social factors are part of
• Processes of pathogenesis and salutogenesis
• Salutogenesis (Antonovsky):
• A sociological approach to understanding health&disease
• What keeps/makes us health (rather than sick), despite enduring stressful circumstances
• Health defined as something other than the absence of disease and
• Investigates the sense of coherence
• Identifies processes linking the sense of coherence and health
• A way of giving a theoretical support to a life-course approach
17

18. Why shifting focus to processes?
18

19. Why metaphysics matter: markers or entities?
19
Traditions of
Entity Hunting
Aetiological standpoint /
Infectious disease model /
Search for pathogens
Mechanistic explanation /
Causally relevant entities
Analytic metaphysics /
Language and ontology /
Focus on particulars

20. Markers of processes
• Towards process-based disease causation
• Bio- and socio-markers are not causes, in the sense of entities that cause
normal of pathogenic processes
• Bio- and socio-markers mark salient points of a process (normal or
pathological) to be understood in causal terms
• Disease causation as information transmission
• Bio- and socio-markers help us track the flow of information from exposure to
clinical outcome
• Bio-social mechanisms are the ‘channels’ in which the information flow, they
are epistemic boundaries in which we look for these markers
20

21. Processes vs entities vs mechanisms
• Go back to initial question about ‘markers’: markers are not (always)
causes
• Causes (of health and disease) are not always entities
• But we can understand health and disease as processes
• Within this processual understanding, thinking in terms of
mechanisms can help identify relevant factors (but not in the form of
one-cause—one-effect)
21

22. The transmission of information
• A development of process theory, or rather going back to the very
origins (Wesley Salmon):
• A process is causal if it is capable of transmitting marks
• Problem: counterfactual formulation
• Reformulate question in (onto)epistemological terms:
• We check whether a process is causal by looking at which marks are (not)
transmitted
• It is not formulated in terms of counterfactuals
• Marks are already there
• Techno-scientific practices are exactly about finding and tracing these marks
• What is most important is the tracking of the transmission
22

23. Why information
• Gives a way of describing reality, of any kind
• The transmission of information can be tracked, measured, described in quantitative or qualitative
way
• See e.g.: biological information
• A light metaphysics, a versatile cement
• In line with Anscombian pluralism
• Activities and interactions is where we look for salient marks of information transmission
• Helps with:
• conceptualisation of link, picking up signal / signature, tracking marks
• It is a form of knowledge construction
• There is an ineliminable role of the epistemic agents in the process of tracking information
23

24. What is information?
• An information-theoretic approach
• See Philosophy of Information
• Semantic information
• Agreed, the most difficult to quantify
• But: the most versatile, as it allows us to express informationally virtually anything
• It is related to an epistemic agent expressing informationally something
• It is related to language, but not reduced to it
24
General Definition of Information:
p is an instantiation of information,
understood as semantic content, if, and only if:
(GDI1) p consists of data;
(GDI2) data in p are well-formed;
(GDI3) well-formed data are meaningful.
(GDI4) meaningful well-formed data are
truthful.

25. Good and bad use of bio- and
socio-markers
25

26. Value-ladenness and value-promoting
Concepts and methods are not neutral instruments
A long-standing, valuable and rich tradition on value-ladenness and inductive
risk
Notice: ladenness goes in 2 directions:
1. Values influence our concepts/methods
2. Values are influenced / promoted by concepts and methods
1. is much more studied than 2.
Values are moral, epistemic, …
26

27. The good use
• Use bio- and socio-markers should contribute to
• Understanding the bio-social mechanisms of health and disease
• Predicting health and social outcomes, from early markers
• Design public health interventions and individual treatment, taking into
account these markers
• Epistemic values, arguably good at ethical level:
• Explanatory, both at individual and group level
• Predictive, only at group level
27

28. The bad use
• Avoid using bio-markers in the following ways
• Interpret markers deterministically
• Arguably wrong and potentially harmful epistemic value
• Justify / validate any discriminatory purpose
• A harmful ethical value
• No predictive use at individual level
• Methodologically and conceptually wrong
• Potentially harmful
28

29. To sum up and conclude
29

30. • Bio-markers brought up many opportunities and challenges to improve on
our understanding of health and disease
• Socio-markers, just like bio-markers, hold promises and raise challenges
• They can enhance a proper bio-social understanding of health and disease
• But including socio-economic factors in the aetiology of health and disease requires an
appropriate methodology, epistemology, and metaphysics
• Methodological pluralism
• Mixed mechanisms
• A process-based view of health and disease
• Causality as information transmission
• Bio- and socio-markers are not value-free
• Their use can be value-laden and value-promoting
• We need explicit ethico-political boundaries that help make the best of their scientific
use
30