Definition of the problem Assistance systems based on machine learning are increasingly being used in medical imaging diagnostics. But can physicians still take responsibility for a diagnosis if they do not fully understand how it came about? Those who blindly trust in technology can hardly fulfill the epistemic condition of responsibility. Arguments Qualitative interviews with radiologists and pathologists on the topics of “responsibility” and “trust” show that physicians only trust artificial intelligence (AI) results if they have the opportunity to (...) control them. Control can create the basis for justified (as opposed to blind) trust. It is worth considering whether such justified trust can also fulfill the epistemic condition of responsibility: Physicians would then no longer have to (be able to) check a specific individual result of the AI, but it would be sufficient that they have previously checked and continuously re-evaluate the expertise of AI for this task. It is clear that the challenges outlined above are by no means specific to AI: Assuming responsibility despite a lack of knowledge is also encountered, among others, in the area of delegation. The fact that internal processes are difficult to comprehend also applies to humans and other technical devices. Conclusion In order to trust AI in a responsible way, physicians need a basic understanding of information technology and a heightened awareness of the respective strengths of humans and machines. They should generally have the opportunity to understand AI results, but there should be a differentiated evaluation of the processes for which traceability is necessary and helpful. AI developers could be held more accountable through product liability. (shrink)

In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

This article explores the profound impact of visualism and visual perception in the context of medical imaging diagnostics. It emphasizes the intricate interplay among vision, embodiment, subjectivity, language, and historicity within the realm of medical science and technology, with a specific focus on image consciousness. The study delves into the role of subjectivity in perception, facilitating the communication of opacity and historicity to the perceiving individual. Additionally, it scrutinizes the image interpretation process, drawing parallels to text interpretation and highlighting (...) the influence of personal biases and individuality in medical practice. By revisiting Husserl’s conceptualization of “image consciousness” and introducing the notion of “image theme”, the paper seeks to establish a theoretical framework for making sense of images within the context of technological interpretation. A key objective is to enhance the phenomenology of technology through a systematic analysis of medical imaging diagnosis, contributing to an expanded epistemological foundation for medical practice. The article recognizes that the construction of medical knowledge incorporates subjective elements, especially within a historical context. The interpretation of images involves both instrumental and expert interpretation, with human subjectivity playing a crucial role. The article asserts that human creativity and conscious engagement are indispensable in interpreting all medical images. (shrink)

Problem The use of artificial intelligence (AI) in prenatal ultrasound diagnostics promises significant improvements in accuracy and efficiency. At the same time, it reshapes the decision-making architecture of pregnancy care, where not only the pregnant woman but also the unborn child appears as a moral agent. Arguments This article examines the ethical implications of AI integration across the three standardized ultrasound examinations stipulated in maternity care. Through a combination of technical framing, ethical analysis, and narrative scenarios, both the potentials (...) and risks are systematically explored. Key ethical concerns include reproductive autonomy, the right not to know, and normative shifts driven by technological feasibility—such as the transition from preventive care to selection. The use of AI is not normatively neutral: it may reinforce societal expectations of normality, health, and the avoidance of disability, thereby reshaping both medical and parental responsibilities. Conclusion An ethically sound integration of AI requires clear conditions: transparency of algorithmic decision-making processes, clearly defined goals for implementation, ongoing quality control of training data, and a deliberate distinction between medical care and broad-based screening. In this way, AI can contribute to diagnostic improvement without itself becoming a norm-setting actor in a sensitive field of medical decision-making. (shrink)

Artificial intelligence (AI), represented by machine learning, artificial neural networks and deep learning, is impacting all areas of medicine, including translational research (from bench to bedside to health policy), clinical medicine (including diagnosis, treatment, prognosis and healthcare resource allocation) and public health. At a time when almost everyone is focused on how to better realise the promise of AI to transform the entire healthcare system, Dr Appel calls for public attention to the AI in medicine and the negative outcome penalty (...) paradox. Proposing this topic has deepened our thinking about the application of AI in clinical diagnostics, and also prompted us to find more effective ways to integrate AI more effectively into future clinical practice. In addition to Dr Appel’s insightful advice, I hope to offer three other possible perspectives, including changing public perceptions, re-engineering clinical practice processes and introducing more stakeholders, to further the discussion on this topic. (shrink)

This reflection explores the gap between explaining and understanding artificial intelligence’s (AI) outcomes, focusing on the example of AI-driven medical diagnostics. Explainable AI (XAI) is fundamentally rooted in machine learning and probabilistic methods, which is why its relationship to domain-specific contexts, such as medical diagnostics or policymaking, as well as to social concepts, such as trust or accountability, remains ambiguous. This creates a gap between what is technically considered as explaining and what, in turn, constitutes the understanding of (...) a model’s predictions and its concrete, situated implications. In our contribution, we draw on the philosophy of science and its contextual notion of scientific understanding to highlight the need for explainable algorithmic outcomes that enable actors to both explain and intervene in creating, applying or interpreting knowledge. Our reflection highlights the potential tension between XAI as providing insights into an AI model’s technical operations and explainability as part of a situated understanding of how the model works within specific social contexts. We believe that bringing the concept of scientific understanding to empirical AI ethics can help us rethink explainability and contribute to more responsible ways of making sense of and interacting with black-box models, particularly in medical diagnostics. (shrink)

The aim of this essay is to consider both Schmitt’s polemical and his analytical claims in dealing with a concept which is central to his theory and yet strangely overlooked by the secondary literature: the concept of friendship. The essay proceeds in three steps; first it makes some textual claims about the meaning and role of friendship in Schmitt’s writings; secondly its puts forward an interpretation of the significance of friendship in Schmitt’s political thought; finally, it tries to disentangle polemics (...) from diagnostics in Schmitt’s discourse and draws some tentative conclusions. (shrink)

Genetic testing has familial implications. Counsellors find themselves in (moral) conflict between medical confidentiality (towards the patient) and a potential right or even duty to warn at-risk relatives. Legal regulations vary between countries. English literature about German law is scarce. We reviewed the literature of relevant legal cases, focussing on German law, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This article aims to familiarise counsellors with their responsibilities, compare the situation between countries and point out (...) legally unresolved areas.According to the German Genetic Diagnostics Act (Gendiagnostikgesetz) in case of an ‘avoidable or treatable’ genetic disorder, geneticists ought to confine themselves to the obligated advice to the patient. Whether a breach of the duty of confidentiality can be justified in exceptional cases by ‘necessity as justification’ for actively informing relatives at risk remains legally unclear. In case of a ‘neither avoidable nor treatable’ genetic disease, geneticists should also refrain from actively informing relatives as the justifiable state of emergency does not permit to break the duty of confidentiality. (shrink)

This monograph contributes to the scientific misconduct debate from an oblique perspective, by analysing seven novels devoted to this issue, namely: Arrowsmith by Sinclair Lewis (1925), The affair by C.P. Snow (1960), Cantor’s Dilemma by Carl Djerassi (1989), Perlmann’s Silence by Pascal Mercier (1995), Intuition by Allegra Goodman (2006), Solar by Ian McEwan (2010) and Derailment by Diederik Stapel (2012). Scientific misconduct, i.e. fabrication, falsification, plagiarism, but also other questionable research practices, have become a focus of concern for academic communities (...) worldwide, but also for managers, funders and publishers of research. The aforementioned novels offer intriguing windows into integrity challenges emerging in contemporary research practices. They are analysed from a continental philosophical perspective, providing a stage where various voices, positions and modes of discourse are mutually exposed to one another, so that they critically address and question one another. They force us to start from the admission that we do not really know what misconduct is. Subsequently, by providing case histories of misconduct, they address integrity challenges not only in terms of individual deviance but also in terms of systemic crisis, due to current transformations in the ways in which knowledge is produced. Rather than functioning as moral vignettes, the author argues that misconduct novels challenge us to reconsider some of the basic conceptual building blocks of integrity discourse. (shrink)

The aim of the article is to show how the use of diagnostic methods allows identifying patterns and problems of corporations functioning, providing identification of directions and strategies for further development of their business. Theoretical and methodological basis of the research is a scientific works of scientists in the field of business diagnostics and strategic development, who studied diagnostics in the system of responding to business development problems, identifying areas for improving strategic management, financial statements of corporations of (...) Daimler Group (Germany), Tesla Motors (USA) and Toyota Motor (Japan) and own research results. The methodological basis of the study is a set of general and special methods used to achieve the goal of the research and includes: theoretical generalization and synthesis – in analyzing the content of scientific works on business diagnostics and strategic management; observation – to obtain primary information about the state of business of automotive companies in the world; indicator and integrated assessment – to assess the state of business and the effectiveness of strategic management of automotive corporations; information and logical analysis – when determining the issues and patterns of business development of corporations; problem-target method – to justify the choice of business development strategies; causation-result method – to obtain definitive conclusions. The results of the study of the state of business of the world's leading automotive corporations revealed the dependence of business efficiency on the degree of efficiency of strategic management of their activities, and identified types of strategies that will promote further development of automotive corporations – integrated, concentrated, diversified or globalized growth. The practical significance of the obtained results lies in their usefulness for strategic management for Daimler Group, Tesla Motors, Toyota Motor Corporation. (shrink)

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as clinical research (...) (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related to (...) ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

How do psychiatrists arrive at their diagnostic conclusions? Though several philosophers of psychiatry have proposed how to understand psychiatric diagnostic reasoning over the last decade, this essential question of the epistemology of psychiatric practice has received little attention. This article introduces the reader to this topic, its importance, and the major theoretical positions presented in the debate, while also pointing to future relevant research in this area of philosophy of psychiatry.

The model of statistical-causal analysis developed by Stegmüller (1973) with reference to Salmon (1970, 1971) is applied to the diagnostic process and suggested as a replacement for the model of inductive-statistical systematization in the context of normative diagnostics (Westmeyer, 1972). For a generalization of the model with respect to discrete random variables, an algorithmic construction of the diagnostic process is given generally and then elucidated by a simple example. It becomes apparent that this model avoids important problems which confront (...) normative diagnostics relying on the model of inductive-statistical systematization. (shrink)

A new diagnostic modeling system for automatically synthesizing a deep‐structure model of a student's misconceptions or bugs in his basic mathematical skills provides a mechanism for explaining why a student is making a mistake as opposed to simply identifying the mistake. This report is divided into four sections: The first provides examples of the problems that must be handled by a diagnostic model. It then introduces procedural networks as a general framework for representing the knowledge underlying a skill. The challenge (...) in designing this representation is to find one that facilitates the discovery of misconceptions or bugs existing in a particular student's encoding of this knowledge. The second section discusses some of the pedagogical issues that have emerged from the use of diagnostic models within an instructional system. This discussion is framed in the context of a computer‐based tutoring/gaming system developed to teach students and student teachers how to diagnose bugs strategically as well as how to provide a better understanding of the underlying structure of arithmetic skills. The third section describes our uses of an executable network as a tool for automatically diagnosing student behavior, for automatically generating “diagnostic” tests, and for judging the diagnostic quality of a given exam. Included in this section is a discussion of the success of this system in diagnosing 1300 school students from a data base of 20.000 test items. The last section discusses future research directions. (shrink)

COVID-19 is one of the most serious diseases caused by the SARS coronavirus. This is a fatal disease, and it becomes difficult to save the life of the infected person because it progresses very rapidly and starts in the lungs and causing damage to the entire body. With the help of advanced machine learning techniques, this disease can be detected early and with very little probability of error. In this paper, we have developed two deep transfer learning models, VGG 16 (...) and MobileNetv2, to detect COVID-19. Both models were applied to datasets based on human lung CT scan images, and their performance was evaluated. To analyze and compare their performance, we have used several performance met- rics such as Prevalence, Null Error Rate, False DR, Negative PV, False OR, LR ratio (+), LR ratio (-), CSI, Accuracy, FM Index, BM, Diagnostic Ratio, MK and Critical Success Index, that have not been used in previous papers. (shrink)

The typical habitat of overt nominative subjects is in finite clauses. But infinitival complements and infinitival adjuncts are also known to have overt nominative subjects, e.g. in Italian (Rizzi 1982), European Portuguese (Raposo 1987), and Spanish (Torrego 1998, Mensching 2000). The analyses make crucial reference to the movement of Aux or Infl to Comp, and to overt or covert infinitival inflection. This working paper is concerned with a novel set of data that appear to be of a different sort, in (...) that they probably do not depend on either rich infinitival inflection or on movement to C. (shrink)

ObjectiveThis study aimed to develop a diagnostic model of multi-kinematic parameters for patients with amnestic mild cognitive impairment (aMCI).MethodIn this cross-sectional study, 94 older adults were included (33 cognitively normal, CN; and 61 aMCI). We conducted neuropsychological battery tests, such as global cognition and cognitive domains, and collected gait parameters by an inertial-sensor gait analysis system. Multivariable regression models were used to identify the potential diagnostic variables for aMCI. Receiver operating characteristic (ROC) curves were applied to assess the diagnostic accuracy (...) of kinematic parameters in discriminating aMCI from healthy subjects.ResultsMultivariable regression showed that multi-kinematic parameters were the potential diagnostic variables for aMCI. The multi-kinematic parameter model, developed using Timed Up and Go (TUG) time, stride length, toe-off/heel stride angles, one-leg standing (OLS) time, and braking force, showed areas under ROC (AUC), 0.96 [95% confidence interval (CI), 0.905–0.857]; sensitivity, 0.90; and specificity, 0.91. In contrast, a single kinematic parameter’s sensitivity was 0.26–0.95 and specificity was 0.21–0.90. Notably, the separating capacity of multi-kinematic parameters was highly similar to Montreal Cognitive Assessment (MoCA; AUC: 0.96 vs. 0.95). Compared to cognitive domain tests, the separating ability was comparable to Auditory Verbal Learning Test (AVLT) and Boston Naming Test (BNT; AUC: 0.96 vs. 0.97; AUC: 0.96 vs. 0.94).ConclusionWe developed one diagnostic model of multi-kinematic parameters for patients with aMCI in Foshan. (shrink)

Experimental philosophy’s much-discussed ‘restrictionist’ program seeks to delineate the extent to which philosophers may legitimately rely on intuitions about possible cases. The present paper shows that this program can be (i) put to the service of diagnostic problem-resolution (in the wake of J.L. Austin) and (ii) pursued by constructing and experimentally testing psycholinguistic explanations of intuitions which expose their lack of evidentiary value: The paper develops a psycholinguistic explanation of paradoxical intuitions that are prompted by verbal case-descriptions, and presents two (...) experiments that support the explanation. This debunking explanation helps resolve philosophical paradoxes about perception (known as ‘arguments from hallucination’). (shrink)

Jürgen Habermas has argued that religious views form a legitimate background for contributions to an open public debate, and that religion plays a particular role in formulating moral intuitions. Translating religious arguments into “generally accessible language” (Habermas, Eur J Philos 14(1):1–25, 2006) to enable them to play a role in political decisions is a common task for religious and non-religious citizens. The article discusses Habermas’ view, questioning the particular role of religion, but accepting the significance of including such counter-voices to (...) the predominant views. Furthermore it is pointed out that not only religious but also numerous secular views stand in need of translation to be able to bear on policy matters. Accepting Habermas’ general framework, I raise the question whether experts (such as clinicians working in relevant specialised areas of care) participating in political debates on biomedical issues have a duty to state their religious worldview, and to what extent the American government decision to restrict embryo stem cell research is an illegitimate transgression of the State-Church divide. (shrink)

Theories of medical diagnosis have been debated since at least the early eighteenth century. They were closely linked to different understandings of health and disease. In general, naturalistic and ontological understandings were confronted with nominalistic and constructivist interpretations of signs and symptoms. The foundations of today’s understanding of diagnosis were laid in the nineteenth century, which brought new ideas about the differentiation of individual diseases. The article reconstructs this development of concepts of medical diagnosis and discussions about the production of (...) diagnostic signs. It then presents two approaches from the 1920s that attempted to reconcile nominalism and essentialism. The focus is on the approaches of the physicians Richard Koch and Francis Crookshank. Their concepts are compared and linked to Hans Vaihinger’s As-If philosophy, which was very prominent at the beginning of the twentieth century. The paper argues that Koch, in particular, sought to give an intentional and relational orientation to the idea of diagnosis, seeing nature and culture in diagnosis not as opposites but as interrelated elements, and that Koch’s and Vaihinger’s approaches still offer much insight into contemporary thinking about the theory of diagnosis. (shrink)

In order to train healthcare professionals in the announcement of serious medical diagnoses, we propose the de-sign of a section of a website that aims to enable caregivers to better control this professional activity that they dread. These diagnoses materialize through language interactions between doctors and patients that are emotion-ally charged. The analysis of these announcement interviews involves access to interactions that are as close as possible to those that take place in real work situations through role-playing. We will show (...) that the design of the website based on the architectural dimension (functional structure of the activity), the relational dimension (roles, co-constructed communication contract) and the communicational dimension (mobilized language processes) allows to identify this sensitive professional activity in its characteristic aspects. Based on a study commissioned by the Ligue contre le cancer, we will show how and in what way the identified dimensions have formative potential and we will highlight their contribution to improving the understanding of the activity and developing training materi-als. (shrink)

Should we be allowed to refuse any involvement of artificial intelligence technology in diagnosis and treatment planning? This is the relevant question posed by Ploug and Holm in a recent article in Medicine, Health Care and Philosophy. In this article, I adhere to their conclusions, but not necessarily to the rationale that supports them. First, I argue that the idea that we should recognize this right on the basis of a rational interest defence is not plausible, unless we are willing (...) to judge each patient’s ideology or religion. Instead, I consider that the right must be recognized by virtue of values such as social pluralism or individual autonomy. Second, I point out that the scope of such a right should be limited at least under three circumstances: if it is against a physician’s obligation to not cause unnecessary harm to a patient or to not provide futile treatment, in cases where the costs of implementing this right are too high, or if recognizing the right would deprive other patients of their own rights to adequate health care. (shrink)

Focusing on computational studies of pericyclic reactions from the late twentieth century into the twenty-first century, this paper argues that computational diagnostics is a key methodological development that characterize the management and coordination of plural approximation methods in computational organic chemistry. Predictive divergence between semi-empirical and ab initio approximation methods in the study of pericyclic reactions has issued in epistemic dissent. This has resulted in the use of diagnostics to unpack computational greyboxes in order to critically assess the (...) effect of specific misrepresentations on predictive accuracy given that approximations and idealizations must be made to render computational models tractable. Furthermore, benchmarking is used to determine the applicability of approximation methods depending on how accurate the results need to be in a given research context. The epistemology of benchmarking consists of the co-generation of data sets in a hybrid computational–experimental form used to standardize computational methods but does not determine a unique quantitative method to be used across computational organic chemistry. (shrink)

In 1889, TheBritish Medical Journalpublished a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at thefin de siècleled to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, but (...) alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels. (shrink)

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society improve (...) health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

A number of novel gene detection techniques all revolve around the ligation of synthetic nucleic acid probes. In such ligase‐assisted gene detection reactions, specific DNA or RNA sequences are investigated by using them as guides for the covalent joining of pairs of probe molecules. The probes are designed to hybridize immediately next to each other on the target nucleic acid strand. Demonstration of ligated probes results in highly specific detection of and efficient distinction between similar sequence variants under standard reaction (...) conditions. Accordingly, the principle has been applied in automated genetic screening procedures. Ligation reactions are also integral to a number of amplification procedures and they will be of value in an expanding range of genetic analyses. (shrink)

Diabetes is regarded as one of the most challenging global health issues of the 21st century. Especially countries with weak health infrastructure are struggling to deal with the increased demands this chronic disease entails. Tracing the effects of a diagnostic device, the glucometer, this book examines how it contributes to the making of diabetes in contemporary Uganda. Arlena S. Liggins demonstrates that depending on who uses the glucometer, the outcomes may go far beyond diagnosis. The book draws a complex picture (...) of hopes and misplaced expectations, of trust and mistrust in a technology to which access in the first place is all but a given. (shrink)

It is argued that the proper way to construct and deliver a therapeutic sermon is to take a theocentric approach. Preaching, rightly understood, is proclamation of the good news that God has redeemed the world through Christ in the power of the Holy Spirit. It is by definition theological. Feeling pressure to be relevant, engaging and contemporary, a significant number of preachers fall into administering mini-doses of psychological self-help from the pulpit. Hans Urs von Balthasar’s homily, ‘Joy in the Midst (...) of Anxiety’, is offered as a positive alternative. The sermon is theologically and homiletically analysed to show why it is an excellent example of theocentric therapeutic preaching. (shrink)

The interdisciplinary research area Cognitive Interaction Technology (CIT) aims to understand and support interactions between human users and other elements of socio-technical systems. Important reasons for the new interest in understanding CIT in sport psychology are the impressive development of cognitive robotics and advanced technologies such as virtual or augmented reality systems, cognitive glasses or neurotechnology settings. The present article outlines this area of research, addresses ethical issues, and presents an empirical study in the context of a new measurement and (...) assessment system for training in karate. Recent advances in the field of cognitive assistance systems enabled largely automatized assessments of individual mental representation structures for action sequences, such as choreographed movement patterns in dance or martial arts. Empirical investigations with karate practitioners of different skill levels demonstrate that advanced software-based survey and algorithmic analysis procedures based on cognitive models generate individualized performance predictions for a movement sequence from theKanku-dai kata(a pre-defined karate movement sequence), which correlated significantly not only with formal expertise (kyu/danrank) but also with the actual likelihood of mistakes in action execution. This information could prospectively be used to define individual training goals for deliberate practice and incorporated into cognitive interaction technology to provide appropriate feedback. We argue that the development of cognitive interaction systems for sport should explicitly take ethical issues into consideration and present a particular developed engineering approach. The potential benefits of such an assistance system for intermediate and advanced practitioners include more effective and flexible practice, as well as supportive effects, and more flexible training schedules. Furthermore, we argue that researchers from the field of sport psychology can benefit from advances in technological systems that enhance the understanding of mental and motor control in skilled voluntary action. (shrink)

This innovative book concentrates on the important distinction between philosophy of medicine and medical philosophy, by expanding the focus from ‘knowing that’ of the first term to the ‘knowing how’ of the latter. Thus, the idea of patient and provider self-discovery becomes integral part, method, and strategy at the basis of therapeutic treatment. Among the most important contributions of this volume, the definition of ‘Central Medicine’, overcoming the dichotomy Western–Eastern medicine and Traditional–Integrative approaches, is presented under the lenses of hermeneutics, (...) with particular regards to neurosciences, psychiatry, and psychology. Evidence-Based and Patient-Centered Medicine are analyzed within the debate on placebo and non-specific effects. Furthermore, the clinical research presented in the appendix investigates the patient-doctor relationship, and the interactive nature of human relationships in general, including environment, personal beliefs, and perspectives on life’s meaning and purpose. Tomasi’s research covers neuroscience, psychology, philosophy, and medicine. In this book, a wide array of questions and answers pertaining to these areas is presented in a clear, readable, and detailed way, satisfying the needs of professionals, students, and anyone who enjoys the exploration of the complexity of human mind, brain, and heart. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, (...) where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (shrink)

Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the D.S.M. affected by financial links with the pharmaceutical industry? To what extent (...) were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a shift (...) in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of “temporal determinism”. Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific (...) markers, relying on a more “mechanistic” or “statistical” form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification’s own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice. (shrink)

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances. But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's history and symptoms. In doing so, (...) these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe. (shrink)

The purpose of this study is to develop and evaluate two diagnostic classification models (DCMs) for scoring ordinal item data. We first applied the proposed models to an operational dataset and compared their performance to an epitome of current polytomous DCMs in which the ordered data structure is ignored. Findings suggest that the much more parsimonious models that we proposed performed similarly to the current polytomous DCMs and offered useful item-level information in addition to option-level information. We then performed a (...) small simulation study using the applied study condition and demonstrated that the proposed models can provide unbiased parameter estimates and correctly classify individuals. In practice, the proposed models can accommodate much smaller sample sizes than current polytomous DCMs and thus prove useful in many small-scale testing scenarios. (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

Scientific disagreements sometimes persist even if scientists fully share results of their research. In this paper we develop an agent-based model to study the impact of diverging diagnostic values scientists may assign to the evidence, given their different background assumptions, on the emergence of polarization in the scientific community. Scientists are represented as Bayesian updaters for whom the diagnosticity of evidence is given by the Bayes factor. Our results suggest that an initial disagreement on the diagnostic value of evidence can, (...) but does not necessarily, lead to polarization, depending on the sample size of the performed studies and the confidence interval within which scientists share their opinions. In particular, the more data scientists share,the more likely it is that the community will end up polarized. (shrink)