There is renewed research and attention to race in epidemiology and medicine, partly owing to developments in population genetics. Yet race is a contested category and poses philosophical questions about the reality of racial categories as well as the ethical and social-political implications of using them. For instance, is race a social construction; and if so, how do racial categories line up with the world? Perhaps more pressingly, should we be using racial categories in epidemiology and...

Medical Nihilism. Is it vestige of a bygone age in medicine beset with treatments like mercury and bloodletting? Or the proper conclusion of a line of argument about our current medical interventions citing problems with contemporary medical research? These problems include the complex pathophysiology of contemporary diseases, the malleability of medical research methods, the biased social nexus of medical research, and a small effect size crisis. Should we have low confidence on average in...

In medicine, consensus statements abound. They’re issued by government agencies and professional societies as the official word on the science and practice of medicine. But what role does expert consensus serve? To summarize the evidence? To deliberate over decision-making? Or to command change? In an era of evidence-based medicine, is expert consensus going extinct? Or is it perhaps more important now than ever? Philosophers studying the social context of medical knowledge may have some...

The cause of tuberculosis is the germ Mycobacterium tuberculosis. Meanwhile, the causes of heart disease are variable: smoking, sedentary lifestyle, bad genes, and so on. Is this just a fact? Did the German microbiologist Robert Koch really discover that Mycobacterium tuberculosis is the cause of tuberculosis? According to some historians and philosophers, it’s more than just a matter of fact. It’s partly a conceptual choice of how we classify diseases, one with important implications for how...

Evidence-based medicine or EBM was introduced in the early 1990s as a move to increase medicine’s uptake of published scientific evidence, especially evidence from clinical epidemiology. It is now the standard, such that its underlying philosophical ideas have become invisible to many. However, since its launch, evidence-based medicine has had its critics, including healthcare professionals and philosophers. Philosophers began to ask questions: what is ‘evidence’ according to evidence-based...

Mental disorders cause suffering for many and pose challenges for the psychiatric profession. Throughout history, the way that society and psychiatry have thought about mental disorders has changed greatly. One area of great difficulty and great change has been psychiatric classification – how psychiatry carves up the realm of mental illness into diagnostic categories. During the second half of the Twentieth Century, the Diagnostic and Statistical Manual of Mental Disorders, the DSM, became...

Health and disease are two concepts that dominate our lives. Analyzing these concepts has also dominated much of the discussion in the philosophy of medicine. Is health merely the absence of disease? Is disease a biological concept, a value-laden concept, or both? Why is it important that we dissect these concepts? Should we do away with them altogether, at least when it comes to the hard cases that generate controversy over who counts as healthy or diseased? In this episode, we provide a...

The mastery of clinical judgment is what separates the expert clinician from the novice. Yet clinical judgment remains somewhat obscure. Is it a tacit knowledge? Or one that can be formulated according to explicit rules? Is it a science? Or a virtue? Has it been replaced or its importance reduced by evidence-based medicine? Or will it soon be taken over from clinicians by intelligent machines? And what is clinical judgment, anyway? In today's consultation, I sit down with four guests ahead...

Delusions are often defined as fixed false beliefs. They run contrary to common sense or counter-evidence that would convince any rational person, like the idea that aliens are communicating with me through a radio chip implanted in my brain, or the thought that my father has been replaced by an imposter, albeit an imposter that is identical to my father in every discernible way. But why do people acquire delusions in the first place? Philosophy is often thought to be a rational activity of...

Often, when philosophical questions are asked about pregnancy, they concern ethical problems about abortion, surrogacy or assisted conception. But the answers to these questions might depend in part on answers to metaphysical questions. One of these metaphysical questions concerns the relationship between the mother and her fetus. Is the mother a biological container for her developing baby, or is the fetus a part of the mother? It’s a question that may have important implications, but it’s...

In recent years, physicians and health scientists have become increasingly concerned about overdiagnosis, the problem of diagnosing too many people as having a disease, be it breast or thyroid cancer, diabetes or pulmonary embolism. When considering who or what is at fault, the list of suspects often includes overly expansive screening programs, increasingly sensitive diagnostic tests, and unnecessary test-ordering. But should the list of the accused also include our definition of disease?...

I had a cold last winter, and so did countless other people. We had sore throats and runny noses and maybe even a cough. At first glance, it seems hard to deny that the common cold is real. But that’s exactly what a disease antirealist would deny, and there are some philosophical arguments to back them up. Not to be outdone, the disease realist has some philosophical arguments at their disposal too. But what does it mean ask whether diseases are real? And are diseases real or not? Today’s...

Vaccine hesitancy is a cautious or critical stance towards vaccines. By some estimates, it is on the rise among the public. Medicine and public health have responded to this state of affairs partly by communicating the evidence on vaccines to the public. But some believe that this approach ignores important aspects of the nature of medical evidence, the values of the public and public health, and the conditions needed to foster trust in our healthcare institutions. These are the kinds of...

Evidence-based medicine. Narrative medicine. Precision medicine. Are these the names of new schools of medicine? Or of new models for medical research or practice? Or are they simply a clever (and in some cases, lucrative) rebranding of older ideas? What do they have to offer medicine? What’s all the fuss about? In part, these recent and influential movements in medicine concern medical knowledge and medical evidence, so what might philosophers studying medical knowledge and evidence have to...

What is medicine? That question certainly has the ring of a paradigmatic philosophical problem. Yet surprisingly few contemporary philosophers have devoted sustained attention to it. Nonetheless, potentially underlying the question ‘what is medicine?’ are problems concerning the goals of medicine, about medical expertise, and about what counts as health and what counts as disease, problems that determine the very scope of medicine and medical practice. So perhaps it’s time to get...

The Best Physician is also a Philosopher. This is the title of a book by Galen, the famous physician of Antiquity. Was Galen right? Or is it that for many problems in healthcare, philosophy is the best medicine? One thing is for certain: medicine is a new frontier for philosophy, and philosophy for medicine. In this episode, I’ve enlisted Dorian Deshauer, psychiatrist at the University of Toronto and Associate Editor of the Canadian Medical Association Journal, to help me speak more about...