对疾病概念的建构论分析

对疾病的界定与解释是整个医学的核心与基础,尽管在不同历史时期都是本体论的疾病观占主流地位,但是纵观整个医学史,人们对疾病的不同界定充分证明了疾病概念问题上的建构论观点.医学上的建构论强调具体的社会环境、组织结构、价值信念、利益和权力关系等对疾病知识的影响.从建构论视角分析,"疾病"是一种功能性界定;疾病是一种价值判断;疾病是一种社会约定.     

Erwiderung an M.E. Omel'janovskij

Ohne Zusammenfassung     

Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond

The goal of typology research is to identify subtypes of alcohol dependent (AD) patients sharing fundamental characteristics and try to match each subtype, with the most precise treatment strategy. This review provides a comprehensive history of the literature on alcohol dependent subtypes starting from the earliest attempt made by Jellinek. The binary models identified most closely with Cloninger and Babor as well as the successively more complex classifications are discussed. Typology classification potentially useful in guiding the treatment of AD patients, especially in the case of the serotonergic medications. Contrasting data suggests that other factors could influence the response to a medication and/or that more complex typologies should be identified. In summary, typology models may assist in the ascertainment criteria for clinical trials performed in behavioral and pharmacotherapeutic interventions. Greater emphasis, however, must be made to more clearly delineate this field of research, while moving toward more standardized typologies.     

达米特"隐含知识"概念析评

在达米特建构意义理论的基本原则中,显示性本是核心原则,是贯穿于达米特意义理论中的一条主线.达米特是基于"隐含知识"概念的哲学分析而提出显示性原则的,"隐含知识"概念构成了显示性原则的理论根基.本文试图在达米特意义理论的背景下,分析"隐含知识"的基本内涵以及它对于意义理论研究的理论价值.     

Steven M. Emmanuel,Kierkegaard and the Concept of Revelation

International Journal for Philosophy of Religion -     

The Behavioral Genetics of Alcoholism

Twin and adoption studies consistently implicate the importance of genetic influences on alcoholism risk, especially in men. Heritability estimates suggest that approximately 50% to 60% of the variability in alcoholism liability is associated with genetic factors. Although there has been progress in identifying specific genes that predispose toward alcoholism, we know relatively little about the nature of the genetic influence on alcoholism risk. We also know relatively little about how genetic factors combine with environmental factors to affect alcoholism risk. Genotype-environment interaction models posit that alcoholism occurs when individuals both inherit a vulnerability to develop alcoholism and are reared in a provocative environment. Such models hold great promise for understanding alcoholism's etiology.     

Medical Informatics and the Concept of Disease

This paper attempts to address the general questionwhether information technologies, as applied in thearea of medicine and health care, have or are likelyto change fundamental concepts regarding disease andhealth. After a short excursion into the domain ofmedical informatics I provide a brief overview of someof the current theories of what a disease is from amore philosophical perspective, i.e. the ``valuefree' and ``value laden' view of disease. Next, Iconsider at some length, whether health careinformatics is currently modifying fundamentalconcepts of disease. To this question I will answerlargely in the negative, and I will provide the sketchof some arguments from current research programs inmedical informatics why I think this is the case. Thisargumentation is supported by a detailed account ofhow the disease profile for beriberi heart disease,used in one of the major medical informaticsdiagnostic programs, QMR (and its ancestorINTERNIST-1), was developed, and why at least thisprogram essentially follows received views oftraditional medicine.The one main exception to theconformity of this program to ``received' views of adisease occurs when the program's designers need tofine-tune a disease definition. This fine-tuning is tocomport with the expert's perspective on the disease,including his or her epistemic values, as well as theprogram's other resources for diagnosing components ofa disease.     

The Significance of the Concept of Disease for Justice in Health Care

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.