James Marcum

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum.

Both religion and science provide powerful images of human origins and human nature. Often these images are seen as incompatible or irreconcilable, with the religious image generally marginalized vis-à-vis the scientific image. Recent genetic studies into human origins, especially in terms of common cellular features like the mitochondrion from females and the Y-chromosome from males, provide evidence for common ancestors called mitochondrial Eve and Y-chromosomal Adam. The aim of this paper is to expound upon the Judeo-Christian and western scientific images of humanity with respect to human origins and human nature, especially in terms of possible reconciliation of the two images.

Today, modern Western medicine is facing a quality-of-care crisis that is undermining the patient–physician relationship. In this paper, a notion of the epistemically virtuous clinician is proposed in terms of both the reliabilist and responsibilist versions of virtue epistemology, in order to help address this crisis. To that end, a clinical case study from the literature is first reconstructed. The reliabilist intellectual virtues, including the perceptual and conceptual virtues, are then discussed and applied to the case study. Next, a similar method is employed to examine the responsibilist intellectual virtues, including curiosity, courage, honesty, and humility, and to apply them to the case study. To round out the discussion, the love of knowledge and both theoretical and practical wisdom are explored and applied to the case study. The paper concludes with a brief discussion of how the notion of an epistemically virtuous clinician addresses the quality-of-care crisis, in terms of the connection between ethical and intellectual virtues, and of the notion’s implications for medical education.

What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention—especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper’s main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care

In this article, I introduce the notion of horizon for scientific practice (HSP), representing limits or boundaries within which scientists ply their trade, to facilitate analysis of scientific discovery and progress. The notion includes not only constraints that delimit scientific practice, e.g. of bringing experimentation to a temporary conclusion, but also possibilities that open up scientific practice to additional scientific discovery and to further scientific progress. Importantly, it represents scientific practice as a dynamic and developmental integration of activities to investigate and analyze the natural world. I use the discovery of the clotting factor, thrombin, and the experiments conducted by the Johns Hopkins physiologist, William Howell, on the enzymatic nature of thrombin to illustrate the notion of HSP. In a concluding section, I compare the notion of HSP to other notions for scientific practice proposed in the history and philosophy of science literature

In the seventeenth century, Newton published his famous experimentum crucis, in which he claimed that light is heterogeneous and is composed of rays with different refrangibilities. Experiments, especially the crucial experiment, were important for justifying Newton’s theory of light, and eventually his theory of color. A century later, Goethe conducted a series of experiments on the nature of color, especially in contradistinction to Newton, and he defended his research with a methodological principle formulated in “Der Versuch als Vermittler.” Goethe’s principle included two elements: a series of experiments and resultant higher empirical evidence, which functioned as mediator between the objective and the subjective . Although the notion of experimentum crucis became popular among scientists for reconstructing experimental research and for justifying theories, especially for rhetorical purposes, Newton’s justification of his theory of light and color is best reconstructed in terms of Goethe’s methodological principle. Finally, Goethe’s principle has important consequences for the contemporary philosophical underdetermination thesis

Since the publication of Edmund Gettier's challenge to the traditional epistemological doctrine of knowledge as justified true belief, Roberts and Wood claim that epistemologists lapsed into despondency and are currently open to novel approaches. One such approach is virtue epistemology, which can be divided into virtues as proper functions or epistemic character traits. The authors propose a notion of regulative epistemology, as opposed to a strict analytic epistemology, based on intellectual virtues that function not as rules or even as skills but as habits of the heart. To that end, they divide the task of clarifying and expounding their notion in the book's two parts.In the first part, Roberts and Wood examine various components that constitute their notion of regulative epistemology. The first are the epistemic goods or goals that drive the epistemic process. What is needed, claim Roberts and Wood, is an enriched notion of these goods rather than the restricted notion of justified true belief. Epistemic agents are more than calculating devices in that …

In the seventeenth century, Newton published his famous experimentum crucis, in which he claimed that light is heterogeneous and is composed of (colored) rays with different refrangibilities. Experiments, especially a crucial experiment, were important for justifying Newton’s theory of light, and eventually his theory of color. Goethe conducted a series of experiments on the nature of color, especially in contradistinction to Newton, and he defended his research with a methodological principle formulated in “Der Versuch als Vermittler.” Goethe’s principle included a series of experiments and resultant higher empirical evidence as mediator between the objective (natural phenomena) and the subjective (theory or hypothesis). Although the notion of experimentum crucis became popular among scientists, even until today, in reconstructing experimental research and for justifying theories, especially for rhetorical purposes, I propose that Newton’s justification of his theory of light and color is best reconstructed in terms of Goethe’s methodological principle. Finally, Goethe’s principle has important consequences for the contemporary philosophical underdetermination thesis.

A notion of experimental series is developed, in which experiments or experimental sets are connected through experimental suggestions arising from previous experimental outcomes. To that end, the justification of Howard Temin’s DNA provirus hypothesis is examined. The hypothesis originated with evidence from two exploratory experimental sets on an oncogenic virus and was substantiated by including evidence from three additional experimental sets. Collectively these sets comprise an experimental series and the accumulative evidence from the series was adequate to justify the hypothesis by persuading the virology community of its veracity. The notion of crucial experiment is also discussed in terms of experimental series.

Robust clinical decision-making depends on valid reasoning and sound judgment and is essential for delivering quality healthcare. It is often susceptible, however, to a clinician’s biases such as towards a patient’s age, gender, race, or socioeconomic status. Gender bias in particular has a deleterious impact, which frequently results in cognitive myopia so that a clinician is unable to make an accurate diagnosis because of a patient’s gender—especially for female patients. Virtue epistemology provides a means for confronting gender bias in clinical decision-making and for correcting or even preventing its impact. The medical literature on cardiovascular and coronary heart disease is used to illustrate the role intellectual virtues can play in redressing the deleterious impact of gender bias on clinical decision-making and practice. Finally, questions are considered surrounding the pedagogy of intellectual virtues for medical students and practicing clinicians in order to provide quality care for patients, regardless of gender.

Metaphysical presuppositions are important for guiding scientific practices and research. The success of twentieth-century biology, for instance, is largely attributable to presupposing that complex biological processes are reducible to elementary components. However, some biologists have challenged the sufficiency of reductionism for investigating complex biological phenomena and have proposed alternative presuppositions like organicism. In this article, contemporary cancer research is used as a case study to explore the importance of metaphysical presuppositions for guiding research. The predominant paradigm directing cancer research is the somatic mutation theory, in which mutated genes are presumed to be ultimately responsible for explaining carcinogenesis. This reductionistic approach to cancer has been criticised recently, and an organistic approach has been proposed. The article concludes with a discussion of the reciprocal interaction of metaphysical presuppositions and scientific practices for investigating cancer's complex nature.

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. According to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine.

Is knowledge in the natural sciences discovered or constructed? For objectivists, scientific knowledge is discovered through investigations into a mind-independent, natural world. For constructivists, such knowledge is produced through negotiations among members of a professional guild. I examine the clash between the two positions and propose that scientific knowledge is the concurrent outcome from investigations into a natural world and from consensus reached through negotiations of a professional guild. Specifically, I introduce the general methodological notion, instituting science, which incorporates both the discovery and the construction processes in the generation of scientific knowledge. To that end, I use a case study from the biomedical sciences to illustrate the notion. I conclude with a discussion of how this methodological notion helps to address the debate between objectivists and constructivists over the generation of scientific knowledge, and of how it compares with others who have also attempted to address the debate.

Proponents of the dual-process theory claim that two distinct types of mental faculties or minds are responsible for human cognition. The first is evolutionarily old and not unique to humans but shared with other organisms. Type-1’s key feature is autonomy from cognitive capacities; hence, it does not require working memory. Type-2 is evolutionarily recent and thought to be uniquely human. Its key feature is reflective cognitive-decoupling of Type-1 processes, if warranted; and it requires working memory. Critics, however, argue that one mind is sufficient to account for human cognition and propose a unimodel theory of cognition. The debate over these theories depends upon metaphysical notions concerning the nature of cognitive capacities and processes; and, how to investigate and explain them. In this paper, I explore these notions in terms of analyzing the metaphysical presuppositions of dualism and monism, and then the methodological approaches of holism and reductionism, as well as the ontological categories of organicism and physicalism, which are often unspecified and/or unexamined in the cognition debate. Clarification of these metaphysical notions and consideration of others is important for progressing towards the debate’s resolution. To that end, a plurimodel theory of cognition—based on a metaphysical presupposition and a methodological approach of pluralism and pragmatism, respectively, as well as on an ontological category of dynamical system—is introduced and discussed.

In this paper, I discuss the role of care and competence, as well as their relationship to one another, in contemporary medical practice. I distinguish between two types of care. The first type, care1, represents a natural concern that motivates physicians to help or to act on the behalf of patients, i.e. to care about them. However, this care cannot guarantee the correct technical or right ethical action of physicians to meet the bodily and existential needs of patients, i.e. to take care of them—care2. To that end, physicians must be competent in the practice of medicine both as evidence—based science (technical competence) and as patient—centered art (ethical competence). Only then, I argue, can physicians take care of (care2) patients’ bodily and existential needs in a compassionate and comprehensive manner. Importantly, although care1 precedes competence, competence—both technical and ethical—is required for genuine care2, which in turn reinforces an authentic care1. I utilize the play Wit, especially the character Jason Posner, and Francis Peabody’s exposition on caring for patients, to illustrate the role of care and competence in contemporary medical practice

Over the past decade, a number of accounting and financial reporting frauds have led to lost stock wealth, destroyed public trust, and a worldwide recession that called for necessary reform. Regulatory responses and systemic reforms quickly followed, and we show that, while necessary, these reforms are insufficient. The purpose of this paper is to forward virtuous professionalism as a necessary path toward restoring financial reporting systems. We take the position of external observer and analyze the accounting profession over time to assess what has transpired within our financial reporting systems. Our analysis reveals that the combined influence of commercialism and regulatory response has led to a systemic decline in accounting’s professional ideals and, as a result, an erosion of public trust. We then propose virtuous professionalism as a necessary process for restoring financial reporting systems based on sociological, professional, and philosophical theories. We argue that virtuous professionalism is necessary for restoring the public servant identity of the accounting professional. We conclude that efforts to restore financial reporting systems should begin with reforms that restore professional identity shaped by virtues.

The reticulated model of scientific rationality includes the goal of the investigation, the method by which the goal is achieved, and the epistemic values needed to assess whether the goal was achieved by the applied method. I expand this model of rationality to include metaphysical assumptions and commitments that inform the origins of epistemic claims. I then explore the rational boundaries between the natural sciences and Christian theology in terms of goals, methods, and metaphysics. Finally, I discuss the advantages and problems of exploring the rational boundaries between science and theology

Biology as a scientific discipline has relied heavily upon advances in chemistry and physics. An inherent danger in this relationship is the reduction of living phenomena to physico-chemical terms. Whitehead's Philosophy of Organism is utilized to examine current methodologies within biology and to evaluate their appropriateness for future research. Hemostatic regulation is employed to illustrate the applications of organistic concepts to biological research. It is concluded that understanding of living entities and their properties as well as possibly life itself will require synthesis of the many analytical elements as informational structures.

The book starts with a scandal, that is, Socrates’s mortality as entailed in the Aristotelian syllogism,All men are mortal,Socrates is a man,Therefore, Socrates is mortal. The scandal pertains to the deduction of Socrates’s death from the logical connections of premises, which, according to Braude, renders it “meaningless.” But, what does this scandal have to do with a philosophical defense of intuition in medicine? For Braude, the scandal is emblematic of a crisis in medicine and philosophy—a crisis in which human mortality is severed from its morality. Braude articulates the crisis with the following question:Where, therefore, between the cracks of universal logic and reifying medicine is there a place for the individual patient, for a response to the cry of pain to which medicine responds, or to the voice of injustice upon which moral philosophy is founded? For him, intuition provides a means to answer the question and thereby to resolve the crisis. It serves as “a bridge be ..

In The Structure of Scientific Revolutions, Kuhn claimed that theory choice is a conversion experience and depends upon the personality or psychology of the individual scientist making the choice. Critics charged Kuhn with an irrational and a relativistic position concerning theory choice, arguing he advocated a subjective instead of an objective approach to how scientists choose one theory over another and thereby undercut epistemic accounts for the generation of scientific knowledge. In response to critics Kuhn insisted that his approach, although subjective, was still rational in that the criteria—composed of epistemic values—determining theory choice operate both objectively and subjectively. Recent work in cognitive neuropsychology, particularly in the dual-process theory of cognition, supports Kuhn’s notion of theory choice. In this paper, I initially discuss Kuhn’s approach to theory choice, along with criticism of it and his response to the criticism, followed by an examination of the dual-process theory of cognition. I then explore the application of dual-process theory to Kuhn’s notion of theory choice, especially in terms of a historical case study from the biomedical sciences. I finally discuss briefly the implications of the dual-process theory for contemporary philosophy of science.

A definitive and authoritative guide to a vibrant and growing discipline in current philosophy, The Bloomsbury Companion to Contemporary Philosophy of Medicine presents an overview of the issues facing contemporary philosophy of medicine, the research methods required to understand them and a trajectory for the discipline's future. Written by world leaders in the discipline, this companion addresses the ontological, epistemic, and methodological challenges facing philosophers of medicine today, from the debate between evidence-based and person-centered medicine, medical humanism, and gender medicine, to traditional issues such as disease, health, and clinical reasoning and decision-making. Practical and forward-looking, it also includes a detailed guide to research sources, a glossary of key terms, and an annotated bibliography, as well as an introductory survey of research methods and discussion of new research directions emerging in response to the rapid changes in modern medicine. “Philosophy needs medicine', Hillel Braude argues, 'to become more relevant'. By showing how modern medicine provides philosophers with a rich source of material for investigating issues facing contemporary society, The Bloomsbury Companion to Contemporary Philosophy of Medicine introduces the opportunities medicine offers philosophers together with the resources and skills required to contribute to contemporary debates and discussions.