Maël Lemoine

I introduce the phrase ‘Galenic Naturalism’ to describe the millennia-old doctrine that death can result either from a natural, that is, universal and necessary, process of deterioration (aging) or from particular and contingent causes, including diseases. While biologists now largely reject this model in aging research, it is still very influential in medical practice, especially when it comes to deciding what should be treated and what should not, among the various conditions of old age. In philosophy as well, Galenic Naturalism still shapes debates about anti-aging medicine and its extremeversion, immortalism. Yet I show that in ethical and philosophical debates around rejuvenation and anti-aging treatments, there sometimes is a tendency to gloss over the biological details of what these interventions would do with the consequence of raising non-relevant questions. In the end, I plea for a clarification of the foundations of the science of aging, with much effect to be expected on medical practice as well as on philosophy.

Because biologization of psychiatric constructs does not involve derivation of laws, or reduce the number of entities involved, the traditional term of ‘reduction’ should be replaced. This paper describes biologization in terms of redefinition, which involves changing the definition of terms sharing the same extension. Redefinition obtains through triangulation and calibration, that is, respectively, detection of an object from two different spots, and tweaking parameters of detection in order to optimize the picture. The unity of the different views of the same object does not occur through derivation from one of them, as reduction suggests, nor does it obtain through mechanistic unity or the goal of explaining one mechanism, as the phrase ‘mosaic unity’ suggests. Instead, it depends on finding a specific angle of observation, from which linguistic consistency matches sound localization in the brain, so that all observations make sense together, just as an anamorphic picture makes clear sense only when observed from the right spot.

Following the neurophenomenological approach, we propose a model of emotional emergence that identifies the experimental structures of time involved in emotional experience and their plausible components in terms of cognition, physiology, and neuroscience. We argue that surprise, as a lived experience, and its physiological correlates of the startle reflex and cardiac defense are the core of the dynamic, and that the heart system sets temporally in motion the dynamic of emotional emergence. Finally, in reference to Craig’s model of emotion, we propose an integrative model of the temporal dynamic of emotional emergence that allows emotions to be distinguished depending on each temporal phase and that involves the following three systems: the brain, the consciousness, and the doubled-sided continuum of the body-heart context, with the heart as the focus within the body during emotion. This model provides the framework for future developments in 1st- and 3rd-person approaches for an integrative understanding of the science of emotion, including the fields of psychophysiology and psychopathology.

La conception traditionnelle des théories scientifiques en philosophie de langue anglaise, qu’on appelle la « received view », et qui culmine au début des années 1960, posait de nombreux obstacles à une conception des théories scientifiques en biologie et en médecine. La conception sémantique des théories scientifiques qui lui succéda permit de lever ces obstacles, mais pas de différencier les théories en biologie expérimentale et en médecine. Le présent article met en évidence comment, en s’appuyant sur cette conception, Schaffner établit la spécificité des théories biologiques et médicales par rapport aux théories physiques, comment Thompson établit que c’est le savoir biologique et non le savoir clinique qui, véritablement théorique, fonde le caractère proprement scientifique de la médecine, et enfin, comment Sadegh-Zadeh peut proposer à son tour des caractéristiques des théories médicales qui leur sont potentiellement spécifiques et les distinguent des théories biologiques.

En France, l'épistémologie de la médecine est facilement réduite à l'étude du magistral essai de Canguilhem, Le normal et le pathologique. Toutefois, ce livre publié il y a plus de soixante-dix ans ne reflète plus l'état des sciences médicales contemporaines, ni celui des débats poursuivis par les philosophes des sciences depuis. Le présent livre, premier du genre en langue française, a pour ambition d'introduire le lecteur à la philosophie des sciences médicales. Ses dix chapitres initieront le lecteur aux débats qui l'agitent, sans que soient requises des connaissances philosophiques ou médicales préalables. Il répond à la fois à la demande de médecins en quête d'une philosophie qui leur parle de leur discipline et de leurs pratiques, et de philosophes à la recherche d'un guide dans ce champ morcelé et dominé par la philosophie d'expression anglaise. [Payot]

Since the turn of the twenty-first century, biomedical psychiatry around the globe has embraced the so-called precision medicine paradigm, a model for medical research that uses innovative techniques for data collection and analysis to reevaluate traditional theories of disease. The goal of precision medicine is to improve diagnostics by restratifying the patient population on the basis of a deeper understanding of disease processes. This paper argues that precision is ill-fitting for psychiatry for two reasons. First, in psychiatry, unlike in fields like oncology, precision medicine has been understood as an attempt to improve medicine by casting out, rather than merely revising, traditional taxonomic tools. Second, in psychiatry the term “biomarker” is often used in reference to signs or symptoms that allow patients to be classified and then matched with treatments; however, in oncology “biomarker” usually refers to a disease mechanism that is useful not only for diagnostics, but also for discovering causal pathways that drug therapies can target. Given these differences between how the precision medicine paradigm operates in psychiatry and in other medical fields like oncology, while precision psychiatry may offer successful rhetoric, it is not a promising paradigm.

Most philosophers of science do philosophy ‘on’ science. By contrast, others do philosophy ‘in’ science (PinS), that is, they use philosophical tools to address scientific problems and to provide scientifically useful proposals. Here, we consider the evidence in favour of a trend of this nature. We proceed in two stages. First, we identify relevant authors and articles empirically with bibliometric tools, given that PinS would be likely to infiltrate science and thus to be published in scientific journals (‘intervention’), cited in scientific journals (‘visibility’), and sometimes recognized as a scientific result by scientists (‘contribution’). We show that many central figures in philosophy of science have been involved in PinS, and that some philosophers have even ‘specialized’ in this practice. Second, we propose a conceptual definition of PinS as a process involving three conditions (raising a scientific problem, using philosophical tools to address it, and making a scientific proposal), and we ask whether the articles identified at the first stage fulfil all these conditions. We show that PinS is a distinctive, quantitatively substantial trend within philosophy of science, demonstrating the existence of a methodological continuity from science to philosophy of science.

In this paper, we provide a macro level analysis of the visibility of philosophy of science in the sciences over the last four decades. Our quantitative analysis of publications and citations of philosophy of science papers, published in 17 main journals representing the discipline, contributes to the longstanding debate on the influence of philosophy of science on the sciences. It reveals the global structure of relationships that philosophy of science maintains with science, technology, engineering and mathematics and social sciences and humanities fields. Explored at the level of disciplines, journals and authors, this analysis of the relations between philosophy of science and a large and diversified array of disciplines allows us to answer several questions: what is the degree of openness of various disciplines to the specialized knowledge produced in philosophy of science? Which STEM and SSH fields and journals have privileged ties with philosophy of science? What are the characteristics, in terms of citation and publication patterns, of authors who get their philosophy of science papers cited outside their field? Complementing existing qualitative inquiries on the influence of specific authors, concepts or topics of philosophy of science, the bibliometric approach proposed in this paper offers a comprehensive portrait of the multiple relationships that links philosophy of science to the sciences.

Aging is an elusive property of life, and many important questions about aging depend on its definition. This article proposes to draw a definition from the scientific literature on aging. First, a broad review reveals five features commonly used to define aging: structural damage, functional decline, depletion, typical phenotypic changes or their cause, and increasing probability of death. Anything that can be called ‘aging’ must present one of these features. Then, although many conditions are not consensual instances of aging, aging is consensually described as a process of loss characterized by a rate and resulting from the counteraction of protective mechanisms against mechanisms that limit lifespan. Beyond such an abstract definition, no one has yet succeeded in defining aging by a specific mechanism of aging because of an explanatory gap between such a mechanism and lifespan, a consensual explanandum of a theory of aging. By contrast, a sound theoretical definition can be obtained by revisiting the evolutionary theory of aging. Based on this theory, aging evolves thanks to the impossibility that natural selection eliminates late traits that are neutral mainly due to decreasing selective pressure. Yet, the results of physiological research suggest that this theory should be revised to also account for the small number of different aging pathways and for the existence of mechanisms counteracting these pathways, that must, on the contrary, have been selected. A synthetic, but temporary definition of aging can finally be proposed.

Philosophers of science have recently focused on the scientific activity of modeling phenomena, and explicated several of its properties, as well as the activities embedded into it. A first approach to modeling has been elaborated in terms of representing a target system: yet other epistemic functions, such as producing data or detecting phenomena, are at least as relevant. Additional useful distinctions have emerged, such as the one between phenomenological and mechanistic models. In biological sciences, besides mathematical models, models now come in three forms: in vivo, in vitro and in silico. Each has been investigated separately, and many specific problems they raised have been laid out. Another relevant distinction is disciplinary: do models differ in significant ways according to the discipline involved—medicine or biology, evolutionary biology or earth science? Focusing on either this threefold distinction or the disciplinary boundaries reveals that they might not be sufficient from a philosophical perspective. On the contrary, focusing on the interaction between these various kinds of models, some interesting forms of explanation come to the fore, as is exemplified by the papers included in this issue. On the other hand, a focus on the use of models, rather than on their content, shows that the distinction between biological and medical models is theoretically sound.

According to the received view, the transportation view, animal extrapolation consists in inductive prediction of the outcome of a mechanism in a target, based on an analogical mechanism in a model. Through an analysis of the failure of preclinical studies of TGN1412, an innovative drug, to predict the tragic consequences of its first-in-man trial in 2006, the received view is challenged by a proposed view of animal extrapolation, the chimera view. According to this view, animal extrapolation is based on a hypothesis about how human organisms work, supported by the amalgamation of results drawn from various experimental organisms, and only predicting the ‘predictive grid’, that is, a global framework of the effects to be expected.

Despite its vagueness Personalized, Precision, P4, P5, individualized, stratified medicine—or p-medicine in short—has become an increasingly popular term in biomedical literature. Philosophers have attempted to analyze what these various terms involve and have discussed consequences for medical practices. In this article, I argue that an important question remains unaddressed: what has made this project of p-medicine convincing to so many? My argument is that without real achievements, it would never have been. I also make the case that these achievements stem from the domain of monoclonal antibodies, a new type of drug that justifies talks of personalized, precise, stratified, etc., medicine. In conclusion, while it may be possible to label any projection in the future of medicine as ‘p-medicine’, it is impossible to overlook mab-medicine as the spearhead.

English summary: Based on the famous essay by Georges Canguilhem on what is normal and pathological (originally published in 1943), extensive philosophical literature (mainly Anglo-Saxon) has attempted to define these concepts and analyze their status. The main discussion focuses on the following question: can you describe health and illness as natural phenomena or are they states that are determined by values? French text. French description: Depuis le celebre essai de Georges Canguilhem sur le normal et le pathologique publie initialement en 1943 et dont l'un des objectifs etait la clarification des concepts de sante et de maladie, une litterature philosophique abondante, principalement anglo-saxonne, s'est attachee a definir ces concepts et a analyser leur statut. Le principal debat de ce domaine emergent de la philosophie de la medecine porte sur la question: peut-on decrire la sante et la maladie comme des phenomenes naturels ou s'agit-il d'etats qui sont determines par des valeurs? Tous les textes presentes dans ce volume ont participe de cette controverse. Ceux de la premiere section accordent une part importante a la composante biologique. Ceux de la seconde donnent le primat a la notion d'action. Ceux de la derniere section mettent en question l'utilite ou la possibilite meme de definir les deux concepts.