Ozan Altinok

Although our health-related concepts such as disease are strongly value bearing and action guiding, we seem to direct these actions towards one singular direction in a very crude sense in general. This singular direction in the contemporary West is the direction of health care. Although what we hold dear as health, and what we try to avoid as disease make a lot of meaning in our lives, the care we need rarely comes and even rarely comes in the form we want from healthcare. One particular problem that I have addressed throughout the work was the generality of disease concept and the diagnostics of the disease model that we have, which focuses on finding and curing particular diseases. There have been enormous developments that has been challenging the limited system of the organism that sees the boundaries as continuous rather than dichotomous. I have advocated for an evolutionary understanding which conceptualizes disease in a way that enables them to see it with reference to organism’s relationship to environment.

This book is about disease, but from a very specific perspective, namely that of evolutionary medicine. It explains evolutionary medicine in its current form, criticizes it, and tries to apply it not directly on disease instances or tokens of disease, but rather the concept of disease. Doing so, the aim of this book is to ask the question; how to build a better concept of disease? The parts of the answer to this question are answered in different chapters piece by piece, trying to give an account of a better concept first and giving an account of how to see the concept of disease grounded differently. This book is not about giving every possible account of disease, or even the major ones including the established or traditional concept. This book is not about providing a singular perspective on diseases in general, however it assumes a general orthodoxy of medicalized disease understanding.

In 1851, American physician Samuel A. Cartwright observed that the slaves were trying to escape captivity. Based on this observation, he tried to understand the reason why this was the case. Looking for causes of events from a biological and medical perspective of his day alone, the answer he found was a very straightforward one. The slaves who tried to run away were suffering from a mental illness, drapetomania (White in Annual Review of Genetics 38:681–707 2008). This mental illness was the cause they tried to run away. Much later, as an unrelated event, in 1973, American Psychiatric Association, decided by 58% of the votes that homosexuality should be removed from Diagnostic and Statistical Manual of Mental Disorders [DSM] (Australian and New Zealand Journal of Psychiatry 37(6):678–683, 2003) (They did not use a vocabulary or a conceptual framework that distinguished gender identity, orientation or behavior. What they meant was more similar to what we can call as sexual orientation now.). This would mean that homosexuality could not be “treated” by psychologists and psychiatrists anymore, since it was no longer a disease in their repertoire. Although they had to tools to “treat” homosexuality, they were not allowed to, since the intervention that they were aiming at was being aimed at a false “disease”.What do examples like these mean, or rather, what to make of these events? Is the concept of disease some kind of normative concept that is used to control and pathologize certain behaviours or traits without any kind of solid scientific grounding as some radical interpretations of constructivism claim? Alternatively, as the extreme counter position to that, are they merely anecdotal examples of the occasional misuse of science that does not even belong to this century due to the proclaimed immerse advancements in science as some naturalists claim? This chapter does not aim to answer this question directly. This chapter does not give a general concept of disease or analyse how the concept of disease have been used either. Instead, this chapter tries to lay out different elements effecting the concept of disease while discussing certain central issues in the discussion of the concept of disease, eventually arguing around the intersection of social aspects in its usage and the biological aspects of the disease concept. I will use a pragmatic approach towards philosophy of science to understand the different aspects of the concept.

The central idea of the chapter is, how new developments in evolutionary biology make us see inheritance in new ways, and these new ways create new possibilities to use them how to use them in medicine. The canonical understanding of evolutionary medicine as discussed so far, does two different things; it uses Environment of Evolutionary Adaptiveness (EEA) concept to define matches and mismatches through the evolutionary history of organisms firstly, and secondly it uses evolutionary perspectives to understand the behaviours of non-organismic entities such as cancer cells and hologenomes. EEA concept will be employed to account for an individualized and specified understanding of disease when it comes to diagnostics and intervention. From that point, I will further assess an understanding of the frontiers of evolutionary medicine and its new capabilities. The central idea is a very simple one; the theories and the tools we use to understand evolution are changing and in return, the general perspective in evolutionary medicine—if it is taken in the broad sense instead of the canonized vision—will change. Eventually, I claim that the new developments in evolutionary biology lead us to see disease in a way in which we must count in the environmental elements and see the concept of disease in an individualized way. This individualization comes in two counts, first as epistemic individualization of the explanation (connected to token character of medical explanations), and second, metaphysical individualization of disease.

Scientists use some concepts that are socially and ethically highly relevant in their research and other kinds of scientific activities. Some of these concepts determine many things in the social domain. How these concepts are related to their practical activity, and what to make of their usage of concepts is an ongoing question, which was made explicit already (Hacking, 1975). Philosophy of science, as well as “meta science” have been dealing with the relationship of scientists to the concepts not very much, preferring to deal with the concepts themselves only. Although within philosophy of science, the “philosophy of science in practice” perspective has put forward attempts to deal with that, and at earlier accounts of Frankfurt School already as well as Science and Technology Studies, there have been perspectives to restore or restructure the relationships between public and scientists, there has not been comprehensive accounts of such study of concepts and their interrelations within the scientific activities. In this regard, the connection between the “normative” elements of concepts and their “descriptive” counterparts have been institutionalized by large, at least within philosophy by separate structures. The aim of this chapter is to introduce the general understanding of “thick concepts”, the concepts that have both descriptive and evaluative properties to start the analysis of both philosophy of science in practice, and ethics of science coordinatively.

In this chapter, my aim is to discuss meaning theories to introduce a more social understanding of thick concepts within the debate, providing a social aspect which can work with Elstein and Hurka’s (Can J Philos 39(4):515–535, 2009) three part model. My main aim is to focus on the socio-linguistic element in the making of meaning rather than focusing on the meaning itself in the classical sense, also because I find it more important to focus on this issue due to the conceptual change I have in mind. In this chapter, I will lay out certain principles with respect to handling of thick concepts within meaning theories and concepts. The aim is not to give detailed accounts of meaning theories here, neither to find the most accurate or comprehensive meaning theory or approach to analyze thick concepts. My main point of departure in this chapter is to defend that, thick concepts are related to language and linguistic activity in many ways. I think there is reason to believe that in most cases meaning theories capture and explain certain aspects of language but fail to do so when the vast diversity of linguistic activity is considered. More generally, certain approaches to language are more suitable to analyze thick concepts for the most usages of thick concepts. When thick concepts are taken as particular phenomena of their own right within philosophy, as it has been central to the debate which approaches to concepts should be employed, it is understandable that there are many different philosophical approaches that are open for analysis. In the this chapter, I will try to employ different kind of usages of the language based not on specific definitions but meanings in their usage to understand the making of meaning. The general aim is to position concepts in general and thick concepts as tools, not only as lasting, truth corresponding elements of the language.

Evolution has a very strict definition and is very central to evolutionary biology itself when the canonized evolutionary understandings of population genetics is at work, which is as strict as “any change in the frequency of alleles within a population from one generation to the next” (Millstein and Skipper, 207, p. 26) in terms of microevolution, or any kind of “process that results in changes in the genetic material of a population over time”. However, when it comes to philosophical and everyday circles, it is difficult to point out the exact meaning of evolution. It can be used as gradual transformation, change in general or a certain kind of progress within public usage. In a sense, it can be said that evolution cannot be defined, but can be shown due to its many connections to other concepts within fields of biology. On the other hand, “evolutionary” has a particular meaning within the scientific community as well as public with respect to the contrast group, non-evolutionary. The contrast class of evolutionary within biology is generally seen as concept of stable from one perspective, and the concept of revolutionary from the other perspective. In this chapter, my usage of evolution and evolutionary are in line with the usages within the scientific community. In the beginning of discussion of evolutionary medicine, it makes sense to clarify the concept of evolutionary first, since medicine itself is a very broad area, towards which evolutionary understandings, perspectives and methods are directed by evolutionary medicine to explain medical phenomena.

The debates around the conceptual change of scientific terms and concepts have traditionally held correspondence theory of truth as the main truth criterion. Be it Kuhnian “paradigms” (Kuhn, The structure of scientific revolutions. University of Chicago Press, 1962), and the proposed solution to this problem with the reference of scientific concepts (Devitt, 1979; Scheffler in Bobbs-Merrill, 1967). I am more sympathetic towards a Lakatosian account of theory change as a larger framework within philosophy of science here, and the implied pluralism in his framework. The more nuanced approaches such as that of Brigandt (2020) and Brigandt and Rosario (2020) are more relevant, yet not the same to my understanding of conceptual change due to changes in research agendas. Here I take a pluralist stance, refusing the incommensurability thesis, following the practice-oriented understandings of concept usage in science, following Hacking (1983) and Cartwright (1983, 1999), which enables scientists to have greater autonomy in making of meaning. I believe that if we carry our focus in meaning to the practice and individual scientist and departmental distinctions shaping their making of meaning following different epistemic goals of making of inferential part of the meaning, we can have a more accurate understanding of conceptual change.

(This is the preprint version) This book is about disease, but disease from a very specific perspective, namely that of evolutionary medicine. However, in doing so, it explains evolutionary medicine in its current form now, criticizes it, and tries to apply it not directly on disease instances or tokens of disease, but rather the concept of disease. Doing so, the aim of this book is to ask the question; how to build a better concept of disease? The parts of the answer to this question are answered in different chapters piece by piece, trying to give an account of a better concept first and giving an account of how to see the concept of disease grounded differently. This book is not about giving every possible account of disease, or even the major ones including the established or traditional concept. This book is not about providing a singular perspective on diseases in general, however it assumes a general orthodoxy of medicalized disease understanding. In this book, I will defend the thesis that, when the concept of disease is seen from perspectives provided by evolutionary biology, the ontology of disease and the surrounding perspectives shall change, leading our understandings in medicine related to concept of disease and social, action guiding concepts to shift towards a more individualized and care based understanding of medicine to overcome the epistemic injustices that are done by the orthodox understanding of disease that prevails in medicine.

Disability studies have been successfully focusing on individuals' lived experiences, the personalization of goals, and the constitution of the individual in defining disease and restructuring public understandings of disability. Although they had a strong influence in the policy making and medical modeling of disease, their framework has not been translated to traditional naturalistic accounts of disease. I will argue that, using new developments in evolutionary biology (Extended Evolutionary Synthesis [EES] about questions of proper function) and behavioral ecology (Niche conformance and construction about the questions of reference classes in biostatistics accounts), the main elements of the framework of disability studies can be used to represent life histories at the conceptual level of the two main “non-normative” accounts of disease. I chose these accounts since they are related to medicine in a more descriptive way. The success of the practical aspects of disability studies this way will be communicated without causing injustice to the individual since they will represent the individuality of the patient in two main naturalistic accounts of disease: the biostatistical account and the evolutionary functional account. Although most accounts criticizing the concept of disease as value-laden do not supply a positive element, disability studies can supply a good point for descriptive extension of the concept through inclusion of epistemic agency.

Social dimension of moral responsibility has started to gain more attention in moral philosophy, be it within the network of action theory, or any other meta-ethical domain. Although there are many social acts and therefore social dimensions of responsibility, I aim to indicate one aspect of sociality in our thinking and practice, particularly in our moral thinking, that is the thick concepts. In this work, I consider Vargas’s concept moral ecology (2015, 2018) as a tool to understand certain social aspects of moral responsibility, while claiming to extend his line of thinking in moral ecology by giving a more active role to the individual agent within the ecology that she is engaged in. I claim that when we understand the relationships between the agent and her surrounding ecology in a more complex, and under certain circumstances in a rather reciprocal way, we can have a better and more nuanced understanding of non-ideal moral landscapes that we are engaged in, while maintaining a certain kind of responsibility to the agents in their social environments. I will use the term niche construction and niche selection – concept that are already at use within the similar biological line of thought within action – to refer to such situations where agents are actively shaping their environments.

Research in infection biology aims to understand the complex nature of host–pathogen interactions. While this knowledge facilitates strategies for preventing and treating diseases, it can also be intentionally misused to cause harm. Such dual-use risk is potentially high for highly pathogenic microbes such as Risk Group-3 (RG3) bacteria and RG4 viruses, which could be used in bioterrorism attacks. However, other pathogens such as influenza virus (IV) and enterohemorrhagic Escherichia coli (EHEC), usually classified as RG2 pathogens, also demonstrate high dual-use risk. As the currently approved therapeutics against these pathogens are not satisfactorily effective, previous outbreaks of these pathogens caused enormous public fear, media attention and economic burden. In this interdisciplinary review, we summarize the current perspectives of dual-use research on IV and EHEC, and further highlight the dual-use risk associated with evolutionary experiments with these infectious pathogens. We support the need to carry out experiments pertaining to pathogen evolution, including to gain predictive insights on their evolutionary trajectories, which cannot be otherwise achieved with stand-alone theoretical models and epidemiological data. However, we also advocate for increased awareness and assessment strategies to better quantify the risks-versus-benefits associated with such evolutionary experiments. In addition to building public trust in dual-use research, we propose that these approaches can be extended to other pathogens currently classified as low risk, but bearing high dual-use potential, given the particular pressing nature of their rapid evolutionary potential.

In this paper, my main aim is to analyse Mao’s conception of Marxist theory and his Marxist subjectivity in theory construction in his three articles. While doing so, I will use two main approaches, first is the idea that Karl Marx’s method in understanding social relations and his theory of knowledge is in many aspects compatible and in continuation with an epistemological reading of Hegel’s subjectivity, and the second is the general structure about the relationship between the object and subject’s process of knowing is similar in all three thinkers. While doing so, I will advocate the position that Mao’s epistemology is compatible with the Marxist understanding of Hegelian epistemology, and that from such an epistemological understanding it is possible to investigate Mao’s three texts in a way that yields, not an orthodox or “end result” Marxism, but instead a more general, meta epistemological understanding of Marx, that is understood better structurally. Eventually, I will claim that while using “scientific” or “orthodox” Marxism as a method to understand society, Mao further uses the subjective element in the same way as Hegel and Marx used it, although eventually he diverts the Marxist subjective manoeuvre to another direction.

Staphylococcus aureus ST45 is a major global MRSA lineage with huge strain diversity and a high clinical impact. It is one of the most prevalent carrier lineages but also frequently causes severe invasive disease, such as bacteremia. Little is known about its evolutionary history. In this study, we used whole-genome sequencing to analyze a large collection of 451 diverse ST45 isolates from 6 continents and 26 countries. De novo-assembled genomes were used to understand genomic plasticity and to perform coalescent analyses. The ST45 population contained two distinct sublineages, which correlated with the isolates’ geographical origins. One sublineage primarily consisted of European/North American isolates, while the second sublineage primarily consisted of African and Australian isolates. Bayesian analysis predicted ST45 originated in northwestern Europe about 500 years ago. Isolation time, host, and clinical symptoms did not correlate with phylogenetic groups. Our phylogenetic analyses suggest multiple acquisitions of the SCCmec element and key virulence factors throughout the evolution of the ST45 lineage.

In this paper, I will briefly summarize the history and current accounts of Evolutionary Medicine (EM). I will show that EM, in its current forms, is using an evolutionary understanding that carries the explanatory framework, as well as explanatory limits, of the Modern Synthesis (MS). I will then point out some essential elements that need to be seen as limiting factors within EM and analyze the limitations that are brought about by the MS understanding of it. On this basis, I will argue that if the latest developments in evolutionary theory are considered – in particular, those pertaining to the inheritance mechanisms highlighted by the Extended Evolutionary Synthesis (EES), and the newly introduced evolutionary entities – EM will have a much broader explanatory scope and increased explanatory power in addition to greater relevance, which will enable its application in medical explanations.