Cancer has garnered increasing interest among philosophers. This chapter focuses on cancer medicine and precision oncology, an influential approach to cancer which seeks to individualize treatment on the basis of genetic or molecular features of disease. It reviews a range of ontological, epistemic, and ethical questions raised by precision oncology, relating developments in cancer medicine to broader issues in the philosophy of science and medicine.

We live in the Age of Big Data. In medicine, artificial intelligence and machine learning algorithms, fueled by big data, promise to change how physicians make diagnoses, determine prognoses, and develop new treatments. An exponential rise in articles on these topics is seen in the medical literature. Recent applications range from the use of deep learning neural networks to diagnose diabetic retinopathy and skin cancer from image databases, to the use of various machine learning algorithms for prognostication in cancer and (...) cardiovascular disease. Many factors are driving the adoption of AI in health care, from... (shrink)

“Actionability” is a key concept in precision oncology. Its precise definition, however, remains contested. This article undertakes a philosophical analysis of “actionability” to aid in conceptual clarification. We map distinct concepts of actionability, arguing that each is best understood as a contextually objective category articulated to mitigate risk of “conceptual slippage.” We defend “interactive pluralism,” acknowledging the need for distinct concepts but also for conceptual interaction in practice. This article thus offers insights for both practitioners and philosophers, clarifying approaches to (...) actionability for scientists and clinicians and serving as a case study to test competing views on scientific pluralism. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

Gender inequality, poverty, racial discrimination, and ecological catastrophes are some of the problems we are currently facing. While these problems may seem to be separate and independent, most of the oppressions could be attributed to the domination of capitalist patriarchy. Ecofeminism sees an intersection behind these oppressions—most of the oppressions could be attributed to the domination of capitalist patriarchy. With a prime focus on environmental issues, ecofeminism suggests that the attitudes and mechanisms behind the mastery over women and nature are (...) not only similar but are one and the same. For ecofeminists, environmental issues are feminist issues. A decoding of the conquest of nature and the... (shrink)

From a rebellious young woman with a dangerous heroin habit to a globe-trotting fashion model to “First Lady of Yoga” (The New York Times), Colleen Saidman Yee tells the remarkable story of how she found herself through the healing power of yoga—and then inspired others to do the same. I’ve learned how to extract the beauty of an ordinary day. I’ve learned that the best high exists in the joy—or the sadness—of the present moment. Yoga allows me to surf the (...) ripples and sit with the mud, while catching glimpses of the clarity of my home at the bottom of the lake: my true self. The very first time Saidman Yee took a yoga class, she left feeling inexplicably different—something inside had shifted. She felt alive—so alive that yoga became the center of her life, helping her come to terms with her insecurities and find her true identity and voice. From learning to cope with a frightening seizure disorder to navigating marriages and divorces to becoming a mother, finding the right life partner, and grieving a beloved parent, Saidman Yee has been through it all—and has found that yoga holds the answers to life’s greatest challenges. Approachable, sympathetic, funny, and candid, Saidman Yee shares personal anecdotes along with her compassionate insights and practical instructions for applying yoga to everyday issues and anxieties. Specific yoga sequences accompany each chapter and address everything from hormonal mood swings to detoxing, depression, stress, and increased confidence and energy. Step-by-step instructions and photographs demonstrate her signature flow of poses so you can follow them effortlessly. Yoga for Life offers techniques to bring awareness to every part of your physical and spiritual being, allowing you to feel truly alive and to embody the peace of the present moment. (shrink)

Minimal residual disease (MRD), a measure of residual cancer cells, is a concept increasingly employed in precision oncology, touted as a key predictive biomarker to guide treatment decisions. This paper critically analyzes the expanding role of MRD as a predictive biomarker in hematologic cancers. I outline the argument for MRD as a predictive biomarker, articulating its premises and the empirical conditions that must hold for them to be true. I show how these conditions, while met in paradigmatic cases of MRD (...) use in cancer, may not hold across other cancers where MRD is currently being applied, weakening the argument that MRD serves as an effective predictive biomarker across cancer medicine. (shrink)

Naturalistic theories of disease appeal to concepts of biological function, and use the notion of dysfunction as the basis of their definitions. Debates in the philosophy of biology demonstrate how attributing functions in organisms and establishing the function-dysfunction distinction is by no means straightforward. This problematization of functional ascription has undermined naturalistic theories and led some authors to abandon the concept of dysfunction, favoring instead definitions based in normative criteria or phenomenological approaches. Although this work has enhanced our understanding of (...) disease and illness, we need not necessarily abandon naturalistic concepts of function and dysfunction in the disease debate. This article attempts to move towards a new naturalistic theory of disease that overcomes the limitations of previous definitions and offers advantages in the clinical setting. Our approach involves a re-evaluation of concepts of biological function employed by naturalistic theories. Drawing on recent insights from the philosophy of biology, we develop a contextual and evaluative account of function that is better suited to clinical medicine and remains consistent with contemporary naturalism. We also show how an updated naturalistic view shares important affinities with normativist and phenomenological positions, suggesting a possibility for consilience in the disease debate. (shrink)

ABSTRACT: Generalizations in medical research can be informative, but also misleading. Building on recent work in the philosophy of science and ethics of communication, I offer a novel analysis of common generalizations in clinical trials as generics in natural language. Generics, which express generalizations without terms of quantification, have attracted considerable attention from philosophers, psychologists, and linguists. My analysis draws on probabilistic and contextual features of generics to diagnose how these generalizations function and malfunction across communicative contexts in medicine. Given (...) a high risk of misinterpretation ("slippage"), I recommend avoidance of generic claims about medical interventions in public contexts, exemplified by clinical trials and medical research more generally. Generics should only be used with vigilance in private contexts, exemplified by the physician–patient encounter. My analysis provides tools to support vigilance when communicating with generics, suggests new norms for public science communication, and raises deeper questions in the ethics of clinical communication. (shrink)

Charles Taylor is one of the most distinctive figures in the landscape of contemporary philosophy. His ability to contribute to philosophical conversations across a wide spectrum of ideas is especially impressive in a time of increasing specialization. These areas include moral theory, theories of subjectivity, political theory, epistemology, hermeneutics, philosophy of mind, philosophy of language and aesthetics. Most recently, Taylor has branched into the study of religion. Written by a team of international authorities, this collection will be read primarily by (...) students and academic professionals in philosophy, political science, and religious studies, and will also appeal to a broad swathe of professionals across the humanities and social sciences. Ruth Abbey is Senior Lecturer in Political Theory at University of Kent at Canterbury. She has published numerous articles and is author of Nietzsche's Middle Period (Oxford University Press, 2000) and Philosophy Now: Charles Taylor (Princeton University Press, 2000). (shrink)

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to volunteerism, and from cooperation to cooption.” Hence, (...) a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)

I thought the paper by Kai-yee Wong and Chris Fraser was fascinating and insightful. Two things I especially appreciated are the clarity with which they summarize my views. I think they are quite fair and accurate. Second, I appreciate their suggestion that the way to deal with the practical problem of weakness of will has much to do with the role of the Background in shaping our actions. I think they are especially on the right track when they say that (...) the improvement of Background skills may actually narrow the range of real options for action, (p. 21) nonetheless, they do not decrease freedom. As they say, “It is a process of strengthening the self, and the agent is likely to experience the concomitant restriction of ‘live’ options not as a limitation but as strength of character.” (p. 21). That seems to me very much on the right track. What they are suggesting, and it is a powerful addition to my own writings, is that we should not just think of the Background as facilitating languages, games and social practices generally, but for morality as well (p. 23). (shrink)

The COVID-19 global pandemic has stretched the capacities of public health institutions and health systems around the world, opening the door to a range of technologically-driven solutions. In this article, we seek to historicize the expanding role of digital health technologies and examine the political-economic context from which they have emerged. Drawing on critical insights from science and technology studies, we maintain that the rise of digital health technologies has been catalyzed by broad shifts in global health governance that have (...) expanded the role of market forces in public health and a unique set of political and economic crises that have accelerated the adoption of digital technologies—often under the guise of appeals to technological innovation to address “unprecedented” crises. These interrelated historical trends, we contend, are critical for understanding current state responses to the pandemic and possibilities for more equitable and democratic applications of technology in public health. (shrink)

Working memory is developed in one region of the brain called the dorsolateral prefrontal cortex. The dysfunction of this region leads to synaptic neuroplasticity impairment. It has been reported that several biochemical parameters and anthropometric measurements play a vital role in cognition and brain health. This study aimed to investigate the relationships between cognitive function, serum biochemical profile, and anthropometric measurements using DLPFC activation. A cross-sectional study was conducted among 35 older adults who experienced mild cognitive impairment. For this purpose, (...) we distributed a comprehensive interview-based questionnaire for collecting sociodemographic information from the participants and conducting cognitive tests. Anthropometric values were measured, and fasting blood specimens were collected. We investigated their brain activation using the task-based functional MRI, specifically in the DLPFC region. Positive relationships were observed between brain-derived neurotrophic factor and Mini-Mental State Examination ; however, negative relationships were observed between serum triglyceride and serum malondialdehyde with right DLPFC activation while the participants performed 1-back task after adjustments for age, gender, and years of education. In conclusion, higher serum triglycerides, higher oxidative stress, and lower neurotrophic factor were associated with lower right DLPFC activation among older adults with MCI. A further investigation needs to be carried out to understand the causal-effect mechanisms of the significant parameters and the DLPFC activation so that better intervention strategies can be developed for reducing the risk of irreversible neurodegenerative diseases among older adults with MCI. (shrink)

The philosophy of empowerment, which is based on the premises that clients must be active, equal and collaborative participants, who are aware and commited to change, has guided research in empowerment interventions. This article reports on a small part of a research study that sought to understand Chinese cancer patients’ conceptualization of empowerment. Qualitative delineation of the concept of empowerment by means of in-depth interviews was carried out with 12 Chinese patients with cancer. The findings showed that empowerment is a (...) process whereby patients develop a sense of inner strength through connection with others, including families, friends and health care professionals. It is also a process of transformation through which they actively develop new perspectives by reframing and reinterpreting their illness. Acceptance of illness was shown to result from a realization of a lack of control in the situation, which is then enhanced by the beliefs of Confucianism and Taoism. In the cancer context, personal control comprises both primary and secondary processes. Active involvement, awareness of the situation, partnership, self-determination and self-reliance are important values in empowerment. The concept and therapeutic foundations of empowerment provide ample legitimacy for its vigorous pursuit in nursing. (shrink)

In my paper, I argue that a first-person perspective (the perspective of a patient/recipient of an action) pertaining to response analysis is significant in Confucianism given the deeply personal nature of Confucianism. It matters whether oneself or others is the patient of an action because Confucianism as a virtue theory emphasizes self-reflection and reflexivity of one’s response in self-cultivation. Moreover, as an account of role-ethics, Confucianism calls attention to one’s particular relationship with others—one reacts differently in kind, not just in (...) degrees, depending on whether one’s or others’ family is at risk. I also appeal to Thomas Nagel’s framework of objectivity vs subjectivity to help elucidate the Confucian position on the value of an individual’s particular perspective, distinguishing the person who is the patient from other people. Finally, I revisit the mirror and the one body analogy discussed by Shun and highlight their point of impartiality rather than objectivity as implied by Shun. (shrink)

Over the last few years, automatic facial micro-expression analysis has garnered increasing attention from experts across different disciplines because of its potential applications in various fields such as clinical diagnosis, forensic investigation and security systems. Advances in computer algorithms and video acquisition technology have rendered machine analysis of facial micro-expressions possible today, in contrast to decades ago when it was primarily the domain of psychiatrists where analysis was largely manual. Indeed, although the study of facial micro-expressions is a well-established field (...) in psychology, it is still relatively new from the computational perspective with many interesting problems. In this survey, we present a comprehensive review of state-of-the-art databases and methods for micro-expressions spotting and recognition. Individual stages involved in the automation of these tasks are also described and reviewed at length. In addition, we also deliberate on the challenges and future directions in this growing field of automatic facial micro-expression analysis. (shrink)

Current methods of operationalizing concepts of misinformation in machine learning are often problematic given idiosyncrasies in their success conditions compared to other models employed in the natural and social sciences. The intrinsic value-ladenness of misinformation and the dynamic relationship between citizens' and social scientists' concepts of misinformation jointly suggest that both the construct legitimacy and the construct validity of these models needs to be assessed via more democratic criteria than has previously been recognized.

As a doxastic voluntarist, I am of the view that what I believe stems from what I want. This does not mean that I believe what I want when I want. It does not mean that in desiring to believe that p, I can bring about the belief that p—just like that. This is not what doxastic voluntarism is about. It must, however, be noted that this is the very conception opponents of the doctrine hold. Doxastic involuntarists maintain that voluntarism (...) is based on this idea of "belief by fiat," where the relation between desiring and believing is close and unmediated—where a subject S's desire to believe that p directly effects the belief that p in S. It is on this misconception that charges of irrationality and incoherence are based. (shrink)

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)

There remains no consensus among social scientists as to how to measure and understand forms of information deprivation such as misinformation. Machine learning and statistical analyses of information deprivation typically contain problematic operationalizations which are too often biased towards epistemic elites' conceptions that can undermine their empirical adequacy. A mature science of information deprivation should include considerable citizen involvement that is sensitive to the value-ladenness of information quality and that doing so may improve the predictive and explanatory power of extant (...) models. (shrink)

Children’s understanding of status and group norms influence their expectations about social encounters. However, status is multidimensional and children may perceive status stratification differently across multiple status dimensions. The current study investigated the effect of status level and norms on children’s expectations about intergroup affiliation in wealth and popularity contexts. Participants were randomly assigned to hear two scenarios where a high- or low-status target affiliated with opposite-status groups based on either wealth or popularity. In one scenario, the group expressed an (...) inclusive norm. In the other scenario, the group expressed an exclusive norm. For each scenario, children made predictions about children’s expectations for a target to acquire social resources. Novel findings indicated that children associated wealth status to some extent, but they drew stronger inferences from the wealth dimension than from the popularity dimension. In contrast to previous evidence that children distinguish between high- and low-status groups, we did not find evidence to support this in the context of the current study. In addition, norms of exclusion diminished children’s expectations for acquiring social resources from wealth and popularity groups but this effect was more pronounced between wealth groups. We found age differences in children’s expectations in regards to norms, but not in regards to status. The implications of how these effects, in addition to lack of effects, bear on children’s expectations about acquiring resources are discussed. (shrink)

Distributional semantic models (DSMs) are a primary method for distilling semantic information from corpora. However, a key question remains: What types of semantic relations among words do DSMs detect? Prior work typically has addressed this question using limited human data that are restricted to semantic similarity and/or general semantic relatedness. We tested eight DSMs that are popular in current cognitive and psycholinguistic research (positive pointwise mutual information; global vectors; and three variations each of Skip-gram and continuous bag of words (CBOW) (...) using word, context, and mean embeddings) on a theoretically motivated, rich set of semantic relations involving words from multiple syntactic classes and spanning the abstract–concrete continuum (19 sets of ratings). We found that, overall, the DSMs are best at capturing overall semantic similarity and also can capture verb–noun thematic role relations and noun–noun event-based relations that play important roles in sentence comprehension. Interestingly, Skip-gram and CBOW performed the best in terms of capturing similarity, whereas GloVe dominated the thematic role and event-based relations. We discuss the theoretical and practical implications of our results, make recommendations for users of these models, and demonstrate significant differences in model performance on event-based relations. (shrink)