A Pragmatic Approach to Conceptualization of Health and Disease

This open access book is an integrated historical and philosophical investigation of several problematic situations that emerge from diverse areas of medical practice. These include (but are not limited to):

• Paying less attention to patients who are suffering with symptoms because no identifiable pathological lesion or pathophysiological process can be found.
• Paying too much attention to patients who are not suffering with symptoms because pathological lesions or pathophysiological processes have been found.
• The tendency to understand patients at risk of developing pathology as being diseased.
• The tendency to disregard the importance of wider societal consequences of definitions of disease and health.

The book shows that many of these problems are related to what disease and health are considered to be and argues that these problems can be addressed by reconsidering the concepts of health and disease employed in practice. It argues for a pragmatic reconceptualization of health and disease that allows clinicians, researchers, and lay people to understand health and disease in many ways, depending on the specific context in which they find themselves and the problems they are trying to solve. In doing so, authors are careful to show how this pragmatism does not endorse “silly” forms of relativism, in which knowledge is reduced to belief or to whatever people find expedient to believe. This work is relevant for philosophers and historians a well as for doctors, health policy makers and other health professionals because it addresses problems sourced from medical practice, albeit using philosophical and historical methods.

Maartje Schermer studied medicine and philosophy. She is a full professor of Philosophy of Medicine and the head of the section Medical ethics, philosophy and history of medicine at Erasmus MC University Medical Center in Rotterdam, The Netherlands. She is a honorary member of the Dutch Health Council, and former chair of the Dutch Centre for Ethics and Health. Her research has focused on, among others, patient autonomy, ethics of emerging medical technologies, screening, biomarkers and predictive medicine; and on human enhancement and neuro ethics. She has published numerous articles and several edited volumes. Maartje was the project leader of Health and disease as practical concepts, a four year project funded by the Netherlands Organization for Scientific Research (NWO).

Nicholas Binney studied philosophy at the University of Exeter, obtaining his doctoral degree in 2017 with a thesis on the historical contingency of medical knowledge. He previously qualified as a veterinary surgeon at the Royal Veterinary College London in 2006, practicing in the UK and the U.S.A.. He is currently a postdoctoral researcher at the Erasmus Medical Center, Rotterdam, working on a project exploring “Pragmatic Concepts of Health and Disease”. This project seeks to understand shifting concepts of health and disease encountered in the new millennium, and to develop a pragmatic framework for selecting suitable concepts for use in different medical contexts. Nicholas published many papers in the philosophy of medicine, focusing on the contingency and objectivity of concepts of disease, and on the evaluation of diagnostic practices. He has published papers on the history of sensitivity and specificity in Annals of Internal Medicine, and on how Meno’s paradox manifests in medical practice, when trying to empirically discover the diagnostic tests that are the most accurate of all, in Synthese. Nicholas has designed and taught courses on critical thinking and the philosophy of medicine at the University of Exeter Medical School, at the University of Oxford, and at the Erasmus University Rotterdam.