This, he suggests, constitutes a betrayal of the key insights of the research into the social determinants of health, and reflects a long-standing tension in the epidemiological community about if and how epidemiological researchers should advocate for radical social change or even point out when radical social change is the only plausible intervention for a population health problem.
We believe that epidemiology and philosophy are ill-served by insularity. Critiques of shutting out non-Western perspectives from philosophy have had a welcome boost of attention that coincides with the simultaneous development of the philosophy of epidemiology literature Van Norden Like the rest of philosophy, philosophy of epidemiology has been slow in this process.
This is why it is so vital that the special issue includes papers that demonstrate the importance of engaging with: indigenous US epistemologies and experiences Meissner , the epistemic framework of Classical Chinese Medicine Lee , and the interplay between Guinean family ethics and scientific practices designed to test a vaccine in a Guinean population in an ethically and epistemically appropriate manner Varghese. As is probably clear by this point, we Valles and Kaplan , see our work and our goals for philosophy of epidemiology as motivated to a great extent by the work of Rose.
Looking at members of a population, clinical medicine e. The question then is what counts as a cause of population - level health outcomes , and how can hypothesized causal pathways be tested? And if the causes identified by this kind of approach are not the sort traditionally addressed in biomedicine, how should epidemiologists respond? But when we turn our attention to the health disparities that exist between populations today, we find ourselves facing stark choices about what kinds of causes we will consider it reasonable for epidemiology to posit and test.
In the papers in this volume, the authors grapple with what it means to find causes in epidemiology, with what kinds of actions are appropriate health interventions at the level of populations, with what counts as a population for the purposes of epidemiological research, and other related issues. Taylor and Valles both argue for new ways of understanding and contending with the conceptual space of philosophy of epidemiology.
Taylor lays out a wide range of ideas and conceptual-theoretical-philosophical debates the distinction between philosophy of epidemiology and epidemiological theory is hazy , which he originally developed as a graduate course in epidemiological thinking. He introduces a large number of questions that he states are outside the scope of that paper, and two of them help clarify what Valles argues in his own paper.
By what means then do philosophers envisage that their accounts can influence researchers? While Taylor is more worried about mapping the key conceptual issues and ideas in epidemiological thinking, Valles is more concerned about how philosophers of epidemiology work within that vast conceptual space.
Valles is motivated by a worry that philosophers of epidemiology seem to pursue their research topics and arguments without explicit or de facto tethering to professional norms of social responsibility. Epidemiologists and other public health scholars have designed stringent sets of professional norms for themselves, asserting among other things that rectifying inequitable health disparities is a chief professional goal, then holding each other publicly accountable when practices diverge from those norms.
Philosophers of epidemiology lack these formal and informal norms, and Valles argues that this needs to change. But the papers by Broadbent, McClimans, Taylor, and Valles all agree on one general point: they all argue for the value of pluralism in debates over approaches to causal inference.
Broadbent takes aim at the Potential Outcomes Approach POA in epidemiology, which proposes a remarkably strict set of rules for when it is proper to speak of a relationship as a causal one, in essentially demanding that causal claims must rely on randomized controlled trials e.
Broadbent objects on both philosophical grounds and on practical grounds. Taking a hermeneutical approach, McClimans is also concerned about epistemic standards and scientific practices that miss the forest for the trees. In other words, these are not merely means of consulting with patients on their subjective opinions about their own health, but rather they are a strategy built around a belief that autonomous patients are the rightful leaders of the processes that attempt to measure their health.
Despite the fact that standardized measures do roughly follow the logic of the capability approach, this logic does not allow for a sufficiently responsive instrument, and thus discriminates against the quality of life of those it does not understand.
Varghese and Jukola both build important connections between philosophy of epidemiology and the growing science-and-values literature. Most importantly, the trial declined to have a placebo control group at all, surmising that the relevant social and ethical value judgments made that option inappropriate, including taking into account the intuitive problem of using placebo vaccines in the midst of an epidemic of a lethal infectious disease.
This, combined with providing healthcare and quarantines for all people in a cluster, and—crucially—respecting the family unit rather than the individual as the socially appropriate unit to include when designing clusters, led to a trial that Varghese argues properly allowed non-epistemic values to override the epistemic value of preferring a randomized control trial.
Jukola expands on a different branch of the science-and-values literature, showing how nutrition science can salvage epistemic trustworthiness from the looming background problem of commercial financial interests directly and indirectly intervening in nutrition science research.
Jukola takes a nuanced view of how commercial interests have impacted the science, neither discarding nutrition science as wholly corrupted nor wholly absolving it. At the level of individual studies, we can and should scrutinize whether scientific methods and other aspects of the research process have been unduly influenced by commercial interests. But there is a macro issue of agenda-setting how is the overall agenda of nutrition science set?
Meissner and Lee demonstrate the value of what a radically more inclusive philosophy of epidemiology could offer, both to philosophy of epidemiology and to other branches of scholarship. Meissner demonstrates how epidemiological and philosophical work on the racial health disparities is ill suited for tracking the health of indigenous US populations. That literature is largely designed to account for Black-White health disparities.
But the complexities of contemporary US indigenous identity patterns challenge these practices. Among those problems: antiquated and overtly bigoted assumptions directly and indirectly control who is eligible for tribal membership and associated access to tribal social services and hence inclusion in associated health outcomes measures, and indigenous identity-formation practices and epistemologies do not map onto the folk racial concepts used in surveys. A key finding is that such data mashups, such as linking weather data e.
Rather, such mashups require careful attention to contexts and purposes. This complicates the epistemic features of the mashup process and of the potential practical uses thereof.
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Is mashing up such data a good means of generating predictions of things such as epidemiological effects of environmental causes? It depends on the relationships between the goals of a specific predictive task and how effectively researchers scrutinize the origins and the context of the data at hand.
Macro Equation models are the oldest type, generating predictions based on epidemiological dynamics equations that represent interactions between the infected and the uninfected, with one key drawback being that the model uses idealizations that do not neatly map onto the ways that real smallpox infected and uninfected people interact. Massive Simulation Models seek to overcome the limitations of Macro Equation Models by modeling the behavior of individual agents by incorporating more and variables, stretching model complexity to the limits of existing computing technologies.
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Abstract Simulation Models take a similar strategy as Massive Simulation Models, but are intentionally restrained for pragmatic reasons, such as to make them more transparent to observers who wish to examine the components of the model. Macro-equation models can be very useful for some policy purposes, despite the presence of idealizations.
Meanwhile, Abstract Simulation Models can be pragmatically superior to the more complex Massive Simulation Models by virtue of being relatively easier to assess and use. Tulodzieki and Williamson offer complementary studies of causal inference in the epidemiology of diseases with disputed etiologies. It is not clear how to evaluate and compare sets of criteria, nor how to decide whether, for a given set of criteria, the evidence suffices to establish causality.
The epistemological framework developed in this paper is intended to address this problem. The major proponents of research into the social determinants of health e. Wilkinson, Marmot, etc. There is nothing ethically or politically neutral about which questions, authors, topics, epistemologies, etc.
The question what is philosophy of epidemiology?
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Even in the development of this special issue that question contributed to the length and difficulty of the process, despite support from the handling Editor-in-Chief Catarina Dutilh Novaes, the Synthese Editorial Assistants, and the journal generally. My Account. Log Out. Search for. Advanced Search. Logged In As. Find More.
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