Exploring the early development of an area of medical literature can inform contemporary medical ... more Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation.
An ongoing project in the philosophy of science and medicine is the effort to articulate a form o... more An ongoing project in the philosophy of science and medicine is the effort to articulate a form of relativism about science that can find a path between strongly realist and pernicious relativist poles. Recent scholarship on relativism has described the characteristics a philosophy must have in order to be considered a thoroughgoing relativism. These include non-absolutism, multiplicity, dependence, incompatibility, equal validity and non-neutrality. Critics of relativism maintain that these requirements cannot be met without collapsing into a pernicious form of relativism and that attempts to do so have failed. Against this view, I argue that the early twentieth century philosophy of Ludwik Fleck satisfies these requirements. Paying attention to the scientific details of Fleck’s account of active and passive elements of knowledge, and the resistance generated by them, reveals a thoroughgoing and yet reasonable relativism about science.
Elselijn Kingma argues that Christopher Boorse’s biostatistical theory does not show how the refe... more Elselijn Kingma argues that Christopher Boorse’s biostatistical theory does not show how the reference classes it uses—namely, age groups of a sex of a species—are objective and naturalistic. Boorse has replied that this objection is of no concern, because there are no examples of clinicians’ choosing to use reference classes other than the ones he suggests. Boorse argues that clinicians use the reference classes they do because these reflect the natural classes of organisms to which their patients belong. Drawing on a thorough exploration of how the disease osteoporosis is defined in adults, I argue that clinicians do indeed make choices about which reference classes to use in diagnosis. Clinicians use young adult reference classes to diagnose osteoporosis in elderly patients. They also use young female reference classes to diagnose osteoporosis in elderly males. Clinicians adjust their reference classes so that the diagnosis of osteoporosis reflects a person’s risk of sustaining a...
Although it is commonly said that the notions of sensitivity and specificity were first defined b... more Although it is commonly said that the notions of sensitivity and specificity were first defined by Jacob Yerushalmy in 1947, the sensitivity and specificity of diagnostic tests have been assessed as far back as the early 1900s. These notions share a common origin with the development of serology. They were originally immunologic concepts, closely associated with the development of complement fixation reactions for syphilis. Here, the authors trace how immunologic sensitivity and specificity were transformed into diagnostic sensitivity and specificity. By relocating the origins of these concepts to the early 20th century, they highlight how these origins were bound to then-commonplace assumptions about specific infectious disease entities.
A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent ... more A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent deployment of circular arguments. Using a case study from the medical literature on the diagnosis of child abuse, I argue that this occurs because researchers fail to distinguish what Ludwik Fleck called the ‘active’ and ‘passive’ elements of knowledge. I review the scholarly literature on this aspect of Fleck’s epistemology to try to understand why it has not been put to more use in the medical literature. Scholars have admitted that Fleck’s account of the active and passive elements of knowledge has confused them, and it has been read in at least three different ways: as an extreme form of relativism, as a form of realism, and as a ‘middle way’ inbetween these poles. I argue that this ‘middle way’ view is both more congenial with the bulk of Fleck’s work, and more palatable to medical practitioners.
Journal of evaluation in clinical practice, Jan 12, 2014
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients' problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
Journal of evaluation in clinical practice, Jan 12, 2014
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients' problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
The measurement of diagnostic accuracy is an important aspect of the evaluation of diagnostic tes... more The measurement of diagnostic accuracy is an important aspect of the evaluation of diagnostic tests. Sometimes, medical researchers try to discover the set of observations that are most accurate of all by directly inspecting diseased and not-diseased patients. This method is perhaps intuitively appealing, as it seems a straightforwardempiricalwayofdiscoveringhowtoidentifydiseasedpatients,which amounts to trying to correlate the results of diagnostic tests with disease status. I present three examples of researchers who try to produce definitive diagnostic criteria by directly inspecting diseased and not diseased patients. Despite this method’s intuitive appeal, I will argue that it is impossible to carry out. Before researchers can inspect these patients to discover definitive diagnostic criteria, they must be able to distinguish diseased and not-diseased patients; and they do not know how to do this, because this is what they are trying to discover. I suspect the intuitive appeal of directlyinspectingpatientsmakesthisdifficulttoappreciate.Tocounterthisdifficulty, I present this problem as a manifestation of ‘Meno’s paradox’, which was described in classical antiquity, and of ‘the problem of nomic measurement’, described more recently. Considering these philosophical problems may help researchers address the methodological issues they face when evaluating diagnostic tests.
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients’ problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
Transversal: International Journal for the Historiography of Science, 2016
A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent ... more A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent deployment of circular arguments. Using a case study from the medical literature on the diagnosis of child abuse, I argue that this occurs because researchers fail to distinguish what Ludwik Fleck called the ‘active’ and ‘passive’ elements of knowledge. I review the scholarly literature on this aspect of Fleck’s epistemology to try to understand why it has not been put to more use in the medical literature. Scholars have admitted that Fleck’s account of the active and passive elements of knowledge has confused them, and it has been read in at least three different ways: as an extreme form of relativism, as a form of realism, and as a ‘middle way’ in-between these poles. I argue that this ‘middle way’ view is both more congenial with the bulk of Fleck’s work, and more palatable to medical practitioners.
Exploring the early development of an area of medical literature can inform contemporary medical ... more Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation.
An ongoing project in the philosophy of science and medicine is the effort to articulate a form o... more An ongoing project in the philosophy of science and medicine is the effort to articulate a form of relativism about science that can find a path between strongly realist and pernicious relativist poles. Recent scholarship on relativism has described the characteristics a philosophy must have in order to be considered a thoroughgoing relativism. These include non-absolutism, multiplicity, dependence, incompatibility, equal validity and non-neutrality. Critics of relativism maintain that these requirements cannot be met without collapsing into a pernicious form of relativism and that attempts to do so have failed. Against this view, I argue that the early twentieth century philosophy of Ludwik Fleck satisfies these requirements. Paying attention to the scientific details of Fleck’s account of active and passive elements of knowledge, and the resistance generated by them, reveals a thoroughgoing and yet reasonable relativism about science.
Elselijn Kingma argues that Christopher Boorse’s biostatistical theory does not show how the refe... more Elselijn Kingma argues that Christopher Boorse’s biostatistical theory does not show how the reference classes it uses—namely, age groups of a sex of a species—are objective and naturalistic. Boorse has replied that this objection is of no concern, because there are no examples of clinicians’ choosing to use reference classes other than the ones he suggests. Boorse argues that clinicians use the reference classes they do because these reflect the natural classes of organisms to which their patients belong. Drawing on a thorough exploration of how the disease osteoporosis is defined in adults, I argue that clinicians do indeed make choices about which reference classes to use in diagnosis. Clinicians use young adult reference classes to diagnose osteoporosis in elderly patients. They also use young female reference classes to diagnose osteoporosis in elderly males. Clinicians adjust their reference classes so that the diagnosis of osteoporosis reflects a person’s risk of sustaining a...
Although it is commonly said that the notions of sensitivity and specificity were first defined b... more Although it is commonly said that the notions of sensitivity and specificity were first defined by Jacob Yerushalmy in 1947, the sensitivity and specificity of diagnostic tests have been assessed as far back as the early 1900s. These notions share a common origin with the development of serology. They were originally immunologic concepts, closely associated with the development of complement fixation reactions for syphilis. Here, the authors trace how immunologic sensitivity and specificity were transformed into diagnostic sensitivity and specificity. By relocating the origins of these concepts to the early 20th century, they highlight how these origins were bound to then-commonplace assumptions about specific infectious disease entities.
A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent ... more A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent deployment of circular arguments. Using a case study from the medical literature on the diagnosis of child abuse, I argue that this occurs because researchers fail to distinguish what Ludwik Fleck called the ‘active’ and ‘passive’ elements of knowledge. I review the scholarly literature on this aspect of Fleck’s epistemology to try to understand why it has not been put to more use in the medical literature. Scholars have admitted that Fleck’s account of the active and passive elements of knowledge has confused them, and it has been read in at least three different ways: as an extreme form of relativism, as a form of realism, and as a ‘middle way’ inbetween these poles. I argue that this ‘middle way’ view is both more congenial with the bulk of Fleck’s work, and more palatable to medical practitioners.
Journal of evaluation in clinical practice, Jan 12, 2014
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients' problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
Journal of evaluation in clinical practice, Jan 12, 2014
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients' problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
The measurement of diagnostic accuracy is an important aspect of the evaluation of diagnostic tes... more The measurement of diagnostic accuracy is an important aspect of the evaluation of diagnostic tests. Sometimes, medical researchers try to discover the set of observations that are most accurate of all by directly inspecting diseased and not-diseased patients. This method is perhaps intuitively appealing, as it seems a straightforwardempiricalwayofdiscoveringhowtoidentifydiseasedpatients,which amounts to trying to correlate the results of diagnostic tests with disease status. I present three examples of researchers who try to produce definitive diagnostic criteria by directly inspecting diseased and not diseased patients. Despite this method’s intuitive appeal, I will argue that it is impossible to carry out. Before researchers can inspect these patients to discover definitive diagnostic criteria, they must be able to distinguish diseased and not-diseased patients; and they do not know how to do this, because this is what they are trying to discover. I suspect the intuitive appeal of directlyinspectingpatientsmakesthisdifficulttoappreciate.Tocounterthisdifficulty, I present this problem as a manifestation of ‘Meno’s paradox’, which was described in classical antiquity, and of ‘the problem of nomic measurement’, described more recently. Considering these philosophical problems may help researchers address the methodological issues they face when evaluating diagnostic tests.
Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will a... more Medics may consider worrying about their metaphysics and ontology to be a waste of time. I will argue here that this is not the case. Promiscuous realism is a metaphysical position which holds that multiple, equally valid, classification schemes should be applied to objects (such as patients) to capture different aspects of their complex and heterogeneous nature. As medics at the bedside may need to capture different aspects of their patients’ problems, they may need to use multiple classification schemes (multiple nosologies), and thus consider adopting a different metaphysics to the one commonly in use.
Transversal: International Journal for the Historiography of Science, 2016
A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent ... more A curious feature of medical literature on the evaluation of diagnostic accuracy is the frequent deployment of circular arguments. Using a case study from the medical literature on the diagnosis of child abuse, I argue that this occurs because researchers fail to distinguish what Ludwik Fleck called the ‘active’ and ‘passive’ elements of knowledge. I review the scholarly literature on this aspect of Fleck’s epistemology to try to understand why it has not been put to more use in the medical literature. Scholars have admitted that Fleck’s account of the active and passive elements of knowledge has confused them, and it has been read in at least three different ways: as an extreme form of relativism, as a form of realism, and as a ‘middle way’ in-between these poles. I argue that this ‘middle way’ view is both more congenial with the bulk of Fleck’s work, and more palatable to medical practitioners.
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Papers by Nicholas Binney