Glut of PhilosEpi papers!

There’s a glut of philosophy of epidemiology papers in the current issue of Studies in History and Philosophy of the Biological and Biomedical Sciences (Dec 2015, vol 54: There is a special section, Prediction in Epidemiology and Medicine, arising from a workshop at KCL organised by Jonathan Fuller and Luis Flores last year. There are also two papers on related themes, not included in that section, but fortuitously published at the same time. All listed below.

2 Jobs: Research Professor at UJ, 1 x permanent and 1 x fixed term

The Faculty of Humanities at the University of Johannesburg has advertised two Research Professorships, one fixed term until 30 April 2019 and one permanent. These positions are open across the humanities disciplines. Primary responsibilities are the publication of excellent research and the supervision of postgraduate students and postdoctoral research fellows. They carry no formal undergraduate teaching responsibilities, although willingness to give occasional lectures on specialised topics is appreciated. The successful candidate is likely to be able to demonstrate a willingness to mentor and supervise as well as a willingness to engage across disciplines. The closing date is 25 October 2015 and details for both jobs are available at

America Tour: Attribution, prediction, and the causal interpretation problem in epidemiology

Next week I’ll be visiting America to talk in Pittsburgh, Richmond, and twice at Tufts. I do not expect audience overlap so I’ll give the same talk in all venues, with adjustments for audience depending on whether it’s primarily philosophers or epidemiologists I’m talking to. The abstract is below. I haven’t got a written version of the paper that I can share yet but would of course welcome comments at this stage.


Attribution, prediction, and the causal interpretation problem in epidemiology

In contemporary epidemiology, there is a movement, part theoretical and part pedagogical, attempting to discipline and clarify causal thinking. I refer to this movement as the Potential Outcomes Aproach (POA). It draws inspiration from the work of Donald Ruben and, more recently, Judea Pearl, among others. It is most easily recognized by its use of Directed Acycylic Graphs (DAGs) to describe causal situations, but DAGs are not the conceptual basis of the POA in epidemiology. The conceptual basis (as I have argued elsewhere) is a commitment to the view that the hallmark of a meaningful causal claim is that they can be used to make predictions about hypothetical scenarios. Elsewhere I have argued that this commitment is problematic (notwithstanding the clear connections with counterfactual, contrastive and interventionist views in philosophy). In this paper I take a more constructive approach, seeking to address the problem that troubles advocates of the POA. This is the causal interpretation problem (CIP). We can calculate various quantities that are supposed to be measures of causal strength, but it is not always clear how to interpret these quantities. Measures of attributability are most troublesome here, and these are the measures on which POA advocates focus. What does it mean, they ask, to say that a certain fraction of population risk of mortality is attributable to obesity? The pre-POA textbook answer is that, if obesity were reduced, mortality would be correspondingly lower. But this is not obviously true, because there are methods for reducing obesity (smoking, cholera infection) which will not reduce mortality. In general, say the POA advocates, a measure of attributability tells us next to nothing about the likely effect of any proposed public health intervention, rendering these measures useless, and so, for epidemiological purposes, meaningless. In this paper I ask whether there is a way to address and resolve the causal interpretation problem without resorting to the extreme view that a meaningful causal claim must always support predictions in hypothetical scenarios. I also seek connections with the notorious debates about heritability.

JOB: UJ, prediction and/or philosophy of epidemiology

The Department of Philosophy at the University of Johannesburg has a fixed term vacancy expiring 30 April 2020, at level Senior Lecturer/Associate Professor/Professor, for someone willing to work on projects related to prediction or philosophy of epidemiology. The vacancy is created by Alex Broadbent’s 5-year appointment as a Dean.

Deadline: 2 August 2015 [NOTE EARLY DEADLINE]

Applicants must hold a PhD in philosophy and must demonstrate strong publication record and potential commensurate with level.

Responsibilities include teaching undergraduate and postgraduate modules, postgraduate supervision, research leading to publications, and assisting with administrative duties as determined in consultation with the Head of Department. Typical teaching load in the Department requires undergraduate teaching for no more than three our of the four terms, and usually the Department aims to organise teaching so as to leave two out of four terms free of undergraduate teaching for each of its staff.

To apply, go to

For further details go to or contact Prof Hennie Lotter

Why would an American medical professional help a tobacco company defend a lawsuit in Korea?

I find myself reading a document by a senior American epidemiologist and medical doctor, commissioned by Philip Morris Korea, in which this individual explains at great length why, in his view, the case of the National Health Insurance Service (NHIS) has brought against the tobacco companies must fail. The NHIS has asked me for an expert opinion, responding to this one.

I cannot help but wonder what would lead an epidemiologist and doctor to deliver a written expert opinion of this nature.

I was offered a fee for my opinion but I refused, since I felt credibility issues are at stake. I am spending my time on this because, first, I believe that the prevailing opinion that epidemiological evidence cannot be applied to the proof of specific causation is incorrect, and second, because I believe that it is worth the effort in this case to argue the point, given the public health burden of tobacco in Korea (where nearly half the male population smokes, and where cancer incidence is the highest in all Asian countries).

I have no idea what motivates my counterpart, but I am surprised that there remain any American epidemiologists who would do anything to help a tobacco company, given the history of the relationship between the profession of epidemiology and tobacco litigation in the USA.

I will double check there is no embargo, and if not, I will publish both the other side’s expert opinion and my own on this blog.

Psychiatric Disorders, Multifactorialism, and Kinds

Today I attended and talked at a great symposium called “What Kinds of Things Are Psychiatric Disorders?” organised by the University Center of Psychiatry at Groningen. The guest of honour was Kenneth Kendler, who gave a long, wide-ranging, and thoroughly excellent talk about the reality or otherwise of the psychiatric disorders captured by the DSM. It was one of the best talks I have heard in a long time, and philosophically more astute than many talks by self-identifying philosophers (including myself). The position he outlined got me thinking about a number of issues in the philosophy of epidemiology and of medicine.

He begins by arguing that realism about psychiatric disorders cannot be modelled on realism about physical kinds: it cannot be like realism about the periodic table. At best it would need to be like realism about biological species – acknowledging the lack of essential properties, the fuzzy boundaries, and so forth. His own view, however, is that realism of even this moderate kind is not warranted about psychiatric disease kinds, at least not those in the DSM. Part of his argument is a pessimistic induction from past psychiatric diagnoses that are no longer recognised. The other part comes from the massive multifactorialism of psychiatric disorders.

One interesting thing about this view is that it also applies to multifactorial diseases outside psychiatry – cancer, for example. The same considerations apply – both the mutlifactorialism, and the pessimistic view of the durability of our current classifications. The two arguments interact, perhaps: massive multifactorialism means that we do not have a good general explanation of why a given set of symptoms occurs, and this lack of explanation indicates that we don’t understand the phenomenon very well and thus that we are quite likely to be wrong about it in some yet-to-be-discovered ways.

Kendler’s view of illness in general, however, is not constructivist. He combines a sceptical stance towards the kinds in the DSM with a realist-leaning pragmatism about psychiatric disorder, the overarching thing, as opposed to the ways we have cut it up. In other words, he thinks that psychiatric illness is a real thing; but he is sceptical about our way of individuating psychiatric diseases. So, at least, I understood his position.

This view also connects in interesting ways with the debate about health in the philosophy of medicine. In that debate, “realism” is not used – instead, “naturalism” is the closest correlate. It is not an equivalent, however, since a naturalist typically denies that there is any normative component to health facts, while Kendler – in response to an acute question from the audience – thinks that health is fundamentally about human goals and suffering, and thus fundamentally normative. The naturalism/normativist debate elides two dimensions of disagreement, one concerning the objectivity of health facts (on which Kendler is a pragmatist, but towards the objective end of the spectrum, opposed to so-called normativists in the health debate), the other concerning whether health is value-laden (on which Kendler appears to be with with the normativists). I have thought for a while that it should be possible to occupy a position like this – agreeing with naturalists on one dimension of disagreement, normativists on another – and I’m pleased to have found someone who does, and someone so credible.

The picture, then, is of a spectrum of disorder which is fairly independent of us, and also normative, but which is fairly arbitrarily cut up by us in our attempts to understand it. That’s a crude summary, of course. But it made me wonder if an exact reverse might also be attractive. Some disease kinds, especially infectious diseases, might suit realism of the kind we might have about biological species. After all, infectious diseases correspond to actual biological species, or something similar enough. Thus we might be (fairly) realist about cholera – it’s what happens when something we are fairly realist about (vibrio cholerae) gets into the small intestine of something else that we are fairly realist about (us). However, we might be irrealist, or less than realist, about health facts in general – not just psychiatric health and disease, but health and disease in general. We might think that health is not a fundamental category – not a kind, not even in the way that species are kinds – and yet think that certain diseases do count as kinds.

I am not sure where this leads, but my hope would be to develop a notion of health and illness – the mere absence of health – as secondary properties, like colour, which depend in non-arbitrary non-contingent ways on us (as opposed to a constructivist stance, which makes facts depend on us in contingent ways). Such a view may make room in the picture for the diagnoser as well as the diagnosed, and it may explain why a particular set of objective characteristics seem to us to belong together as “health” or as a given illness, despite the fact we often find little objective to bundle them together. Perhaps it also would answer to Kendler’s pragmatist intuitions, which I also find very compelling.

Whatever the prospects for Kendler’s view or for this hastily-sketched alternative, the lecture really helped me pull together a number of these issues. It left me thinking that the overarching goal for contemporary philosophical work on the nature of health and disease must be to link the debates about the status of health (naturalism, normativism, and all that) with debates about the status of disease kinds and with the literature on natural kinds more generally. Kendler’s excellent talk today embarked on this extremely complex task and went a remarkable way towards offering a comprehensive and plausible position.