Studies in History and Philosophy of Science最新文献

{"title":"Evidence-based medicine and the promises and limits of digital health and wearable technology","authors":"Stefano Canali,&nbsp;Viola Schiaffonati,&nbsp;Andrea Aliverti","doi":"10.1016/j.shpsa.2025.102097","DOIUrl":"10.1016/j.shpsa.2025.102097","url":null,"abstract":"<div><div>New approaches to biomedical evidence are emerging in relation to innovative technologies and data sources. These include digital health, which promises to revolutionise established paradigms such as Evidence-Based Medicine (EBM) and address longstanding criticism from philosophy and beyond. In this paper, we investigate the promises and show the limitations of digital health for the epistemology of medicine. Focusing on a paradigmatic type of digital health technologies – wearable devices – we specify the key epistemic assumptions at the basis of digital health and show their grounding on ideas of internal and external validity that come from EBM and promise to fix its limitations. Hence, digital health is expected to address longstanding issues of EBM and expand and reinforce its paradigm, and yet going in this direction exacerbates and creates concerns for the epistemology of medical evidence, with ethical and social implications too. In observational studies, we show that wearables are used with the assumption of extending EBM approaches to internal validity. Yet new and different issues emerge, leading to complicated trade-offs and concerns about overdetection and high false positive rates. In intervention studies, wearables are used with the assumption of creating a larger and more diverse evidential basis, potentially mitigating concerns about external validity. However, we argue that this can exacerbate and create new issues of representativity. Behind the hype, we thus paint a nuanced picture of the contribution of digital health to EBM and biomedical research and show the need to acknowledge limitations to avoid harmful applications.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"116 ","pages":"Article 102097"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The conceptual evolution of exclusion rules in the DSM: Problems with determining when one diagnosis should rule out another","authors":"Rachel Cooper","doi":"10.1016/j.shpsa.2025.102107","DOIUrl":"10.1016/j.shpsa.2025.102107","url":null,"abstract":"<div><div>For each mental disorder listed in the <em>Diagnostic and Statistical Manual of Mental Disorders</em> (DSM), the classification provides diagnostic criteria which list the symptoms required for diagnosis. Most sets of diagnostic criteria incorporate exclusion criteria, which state that a diagnosis can only be made in the absence of certain other diagnoses (for example, a specific learning disorder can usually only be diagnosed in the absence of intellectual disability). Exclusion criteria make it clear whether diagnoses can be made together or are exclusive. In the absence of such guidelines, diagnoses will not be reliable and the prevalence of conditions cannot be measured. Through tracing the conceptualisation of exclusion criteria across the DSM series, I show that exclusion criteria are necessary, but that determining what they should be has been intractably difficult. The exclusion rules employed by a classification reflect basic ontological and theoretical judgements about the causal structure of psychopathology. Pragmatic judgements also often play a role. As such, exclusion criteria introduce multiple tensions into the DSM system. On the one hand, exclusion criteria are required. On the other hand, the fact that exclusion criteria often rely on theoretical suppositions undermines any claims that the DSM can avoid controversial commitments. At the same time, the role played by pragmatic concerns, which are by nature often context dependent, threatens the employment of the DSM as a multi-purpose classification used world-wide. More fundamentally, difficulties around determining exclusion rules can arise because it is often unclear how mental disorders might be individuated, and such difficulties undermine hopes that the DSM might describe ‘natural kinds’ of disorder.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"116 ","pages":"Article 102107"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-freedom & patient autonomy","authors":"Anke Bueter,&nbsp;Thor Hennelund Nielsen,&nbsp;Somogy Varga","doi":"10.1016/j.shpsa.2026.102129","DOIUrl":"10.1016/j.shpsa.2026.102129","url":null,"abstract":"<div><div>A longstanding debate in philosophy of medicine—whether disease concepts are value-free (naturalism) or value-laden (normativism)—intersects with broader discussions about patient autonomy and the move away from paternalistic practices. An important argument supporting naturalism is the idea that value-freedom is necessary to protect patient autonomy. This paper challenges that view, arguing that autonomy does not require value-freedom. We first demonstrate that prominent theories of personal autonomy do not demand value-freedom but rather a responsible way of dealing with normative judgements. Drawing on parallels to debates on values in science, we distill three strategies for managing non-epistemic values responsibly: transparency, value diversity, and prioritization of appropriate values. Applying these strategies to medicine, we illustrate how value-ladenness can align with patient autonomy when managed appropriately.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"116 ","pages":"Article 102129"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting the quantum mechanics of cosmology","authors":"David Wallace","doi":"10.1016/j.shpsa.2025.102101","DOIUrl":"10.1016/j.shpsa.2025.102101","url":null,"abstract":"<div><div>Quantum theory plays an increasingly significant role in contemporary early-universe cosmology, most notably in the inflationary origins of the fluctuation spectrum of the microwave background radiation. I consider the two main strategies for interpreting (as opposed to modifying or supplementing) standard quantum mechanics in the light of cosmology. I argue that the conceptual difficulties of the approaches based around an irreducible role for measurement — already very severe — become intolerable in a cosmological context, whereas the approach based around Everett’s original idea of treating quantum systems as closed systems handles cosmological quantum theory satisfactorily. Contemporary cosmology, which indeed applies standard quantum theory without supplementation or modification, is thus committed — tacitly or explicitly — to the Everett interpretation.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"116 ","pages":"Article 102101"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sanctity of grief: A critique of the introduction of “prolonged grief disorder” in the DSM (The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association)","authors":"Miriam Solomon","doi":"10.1016/j.shpsa.2026.102128","DOIUrl":"10.1016/j.shpsa.2026.102128","url":null,"abstract":"<div><div>Grief following bereavement can be an intense, painful, and incapacitating experience, with significant morbidity and even mortality. Nevertheless, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (henceforth DSM), since its third edition in 1980, has been steadfast in claiming that (normal) grief is not a condition calling for psychiatric intervention but, instead, a natural process involving acceptance, adjustment and meaning making. The so-called “bereavement exclusion,” specified by DSM-III and DSM-IV from 1980 to 2013, explicitly ruled out the diagnosis of major depressive disorder (which shares significant symptoms with grief, e.g. sadness, sleep disturbances) for some time (two months to two years) following bereavement. The 2013 removal of the bereavement exclusion, in DSM-5, proved controversial, even though the intention was not (as some critics claimed) to “pathologize” grief but rather to distinguish it more carefully from psychiatric disorders (such as major depressive disorder) sometimes triggered by the <em>stress</em> of grief following bereavement. I will argue that a consequence of the DSM-5's removal of the bereavement exclusion is the introduction of a new diagnosis of “prolonged grief disorder” (PGD) in DSM-5-TR (2022). I have found that there are unacknowledged assumptions about the “normality”—indeed even the <em>sanctity</em>--of grief following bereavement as well as assumptions about the “abnormality” of psychiatric disorder that have shaped DSM deliberations. I am critical of these assumptions and argue that they resulted in a PGD category too narrowly defined to address the needs of many bereaved people, as well as the needs of those grieving losses other than bereavement. I make suggestions for approaching the issues with a stronger focus on two important goals of psychiatry, which are to address suffering and to avoid stigmatizing psychiatric disorders.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"116 ","pages":"Article 102128"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The views of Danylo Samoylovich (1744–1805) on the prevention, course and treatment of the plague","authors":"Olga Gaidai","doi":"10.1016/j.shpsa.2025.102099","DOIUrl":"10.1016/j.shpsa.2025.102099","url":null,"abstract":"<div><div>In the paper I analyse Danylo Samoylovich's views on the prevention, course and treatment of the plague. In addition to the traditional method of source analysis, I also use other theoretical tools: anthropology of knowledge, theory of modernisation as well as institutionalisation, medicalisation and professionalisation. Both Russian and Ukrainian authors call Samoylovich the father of national epidemiology. There is no doubt that his accomplishments have been exaggerated in Russia and Ukraine, but in no way does this detract from Samoylovich's significance, both in his contributions to theoretical medical thought and to practical preventive and therapeutic measures, especially in epidemiology. Samoylovich was part of the modernisation of the Russian Empire, forced through by Catherine II and her entourage. As someone who served in a variety of roles in anti-plague actions, including quarantine physician and chief physician of plague hospitals, Samoylovich can be regarded as a symbol of the institutionalisation and professionalisation of health care in the Russian Empire. By promoting preventive and therapeutic principles, applying them on a large scale, he contributed significantly to the medicalisation of society.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"115 ","pages":"Article 102099"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the social contract for science","authors":"R.M. Morgan ,&nbsp;E.A. Levin ,&nbsp;R. Haslam ,&nbsp;M. Biriotti","doi":"10.1016/j.shpsa.2025.102106","DOIUrl":"10.1016/j.shpsa.2025.102106","url":null,"abstract":"<div><div>The conceptual framework that presents scientific researchers in a transactional relationship with wider society, receiving funding and autonomy in exchange for producing beneficial discoveries and outcomes, is generally known as the social contract for science. This contract has been revisited multiple times, with iterations evolving as ‘wicked problems’ have become identified by many as priorities for research, and as funding models have become more generally tied to predefined or applied outcomes. In parallel, within the Arts and Humanities, there has been growing discourse on the characteristics and ramifications of ‘Modernism’, ‘Postmodernism’, ‘Liquid Modernity’, and ‘Metamodernism’. This paper juxtaposes these two separate bodies of thought, and in doing so, identifies that both are underpinned by similar core themes: (1) ‘trust’ (including a loss of trust in professional researchers, or objective, unproblematic truth), (2) ‘acceleration’ (including acceleration of research outputs), and (3) ‘crisis’ (including narratives of risk, urgency, and emergency underpinning research). Comparison also reveals the importance of narrative, ‘polylogue’, and transparency in navigating modern research into ‘metacrises’. Considering the next iteration of the Social Contract for Science may be helpful in navigating uncertainty, complexity, and (in some quarters) dissatisfaction with the current funding model of university research.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"115 ","pages":"Article 102106"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A goal-directed approach to disease classification","authors":"Adrian Erasmus","doi":"10.1016/j.shpsa.2025.102098","DOIUrl":"10.1016/j.shpsa.2025.102098","url":null,"abstract":"<div><div>Disease classification plays an important role in numerous medical goals, from improving communication between researchers, physicians, and insurers to diagnosis and therapeutic prediction. Therefore, it's important to understand the principles behind our classificatory practices with a view to adopting the approach to disease classification that best serves the practical interests of medical science. In this paper, I discuss three prominent approaches to disease classification: the etiological approach, symptom-based approach, and pathophysiological approach, highlighting strengths and weaknesses of each. My main goal is to defend a pragmatic goal-directed approach to disease classification. I argue that choices about which classificatory approach to use should principally depend on the medical goal being pursued. Drawing from existing pragmatic accounts of classification in science, I suggest that the goal in question determines what kind of information about a disease is important and this, in turn, determines which classificatory approach to apply in service of that goal.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"115 ","pages":"Article 102098"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social emergence and unpredictability","authors":"Simon Lohse","doi":"10.1016/j.shpsa.2025.102096","DOIUrl":"10.1016/j.shpsa.2025.102096","url":null,"abstract":"<div><div>I analyse arguments for social emergentism based on the notion of unpredictability. After examining and ultimately rejecting weak emergentism as relevant theoretical counterpart to (predictive) reductionism, I discuss three arguments asserting that social phenomena should be considered strongly emergent as they are in-principle unpredictable. The main results are a clearer grasp of the premises underlying an emergentist case for unpredictability and that none of the discussed arguments succeeds when confronted with the actual practice of contemporary social science. This conclusion contributes to a deeper understanding of the concept of unpredictability and the prospects of a theory of emergence in social science.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"115 ","pages":"Article 102096"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Farr's cholera law of elevation a counterexample to selective realism?","authors":"Chrysi Maria Malouchou Kanellopoulou","doi":"10.1016/j.shpsa.2025.102105","DOIUrl":"10.1016/j.shpsa.2025.102105","url":null,"abstract":"<div><div>William Farr, a renowned nineteenth-century disease theoretician, successfully predicted mortality rates due to cholera in London and Liverpool through the law of elevation, a law inversely correlating mortality from cholera with the elevation of the land. Farr's elevation law and its successful predictions were made within the framework of miasma theory – a theory now considered false, which postulated that diseases, such as cholera, were caught when inhaling toxic odours. Tulodziecki (2021, 2017) points out that Farr's elevation law is a counterexample to selective realism, the position according to which the theoretical elements essentially responsible for the success of a theory are likely to be true. This paper argues that Farr's elevation law was an empirical discovery, essentially independent of the false assumptions of miasma theory, even though the law was considered compatible with these assumptions. Given the empirical nature of Farr's discovery, the success-to-truth inference defended by selective realists does not apply in the first place, and Farr's elevation law is not a counterexample to selective realism.</div></div>","PeriodicalId":49467,"journal":{"name":"Studies in History and Philosophy of Science","volume":"115 ","pages":"Article 102105"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}