Philosophy of the Biomedical Sciences

Katherine Valde (Boston University) - This talk examines the use of processual concepts in the context of carcinogenesis research. There has recently been an increased interest in the prospect of a process framework for biology, and much of the attention has been focused on whether a process ontology can describe the biological world more accurately than a substance or mechanistic ontology. Bertolaso and Dupr´e (2018) have even argued for a processual understanding of cancer as metaphysically superior to a substance-based understanding. Yet this recent process literature has failed to pay attention to the practical role philosophical frameworks play in guiding scientific expectations and thereby laying out a program of research. To fill this gap, I do not focus on the metaphysical accuracy (or lack thereof) of a process ontology, but instead I take a practice-oriented approach. I look to the specific scientific context of cancer in order to understand how adopting a process framework can advance the field; I argue for the importance of process on methodological (rather than metaphysical) grounds. A processual account characterizes entities in terms of how they are maintained or stabilized, and in general focuses on the generation of stability rather than facts about stability. A traditional mechanistic framework, on the other hand, looks at a system in terms of entities and activities – it looks to finitely characterize the properties of entities that allow them to execute particular actions. These abstract frameworks generate different expectations that guide different research programs. Most simply, a process framework calls on us to expect changes and explain stability, while a mechanistic framework does just the opposite, calling on us to expect stability and explain change. Competing theories in carcinogenesis research can be understood and processual or mechanistic respectively. The dominant theory for understanding cancer is somatic mutation theory (SMT). SMT holds that cancer is a cell-based disease that occurs when a single cell from some particular tissue mutates and begins dividing out of control. A competing theory of carcinogenesis, Tissue Organizational Field Theory (TOFT), holds that cancer is a tissue-based disease that occurs when relational constraints are changed. The primary difference between SMT and TOFT is the default expectations for the operation of the system. In SMT the expectation is for a system to stay unchanged and stable, cells are considered to be quiescent, and when an oncogenic driver mutation occurs it acts independently of context. However, the expectation under TOFT is that the system will undergo continual change akin to development, that in the absence of restriction cells will proliferate with variation and motility, and that carcinogenesis is context dependent. TOFT can be characterized as providing a processual understanding of carcinogenesis, while SMT provides a mechanistic account. While SMT and TOFT will guide different experiments, direct our attention towards the observation of different aspects of a system, and make theoretical commitments to different observables, they are not fundamentally incommensurable theories (Bedessem and Ruphy, 2015). Thus their metaphysical accuracy is not of supreme scientific importance. What is most important is how these expectations guide researchers towards more or less successful practices. While SMT has yielded some success, some researchers think TOFT is a more promising approach (Soto and Sonnenschein, 2005). The continued use of the default mechanistic framework (SMT) is likely to continue yielding similar results. Using a novel framework, that generates different expectations, will call upon scientists to generate novel methods. In the life-threatening context of cancer, the practical ability of a process framework to guide novel research, and thus the ability of TOFT to shift research expectations is of paramount importance. Given the difficulty in settling theoretical metaphysical debates, and the grave importance of advancing biomedical research generally, this pragmatic practice-centered approach to adopting a process framework offers a superior route forward.

Susan Kennedy (Boston University) - While biological reproduction may be a natural phenomenon, the fact that biological parents are responsible for raising their children is not. It is a matter of convention that our social and legal institutions are designed in such a way that procreation leads to parental rights. While the fundamental right to parent has been persuasively argued for by Brighouse and Swift (2006), there is not yet a convincing argument that establishes a right to parent one’s own biological child. This becomes problematic in light of the ‘re-distribution proposal.’ Until the relationship between procreation and parenthood is defended, there is an open question as to why children should not be re-distributed away from their biological parents when it would be in the child’s best interests to do so. The Causal Account offered by Jeffrey Blustein (1982) is a relatively intuitive view. Essentially, parents are responsible for the children they cause to exist. One problem with this view is the unequal causal roles of mothers and fathers with respect to pregnancy. The parental rights and obligations of the mother seem to start at conception, whereas the father’s parental rights begin the moment the child is born. This leads to the perceived result that the mother has more of a claim to the biological child than the father does. However, the procreative role of parents has the potential to be equalized in light of advances in biotechnology that have led to the development of ectogenesis. With this technology, a fetus would undergo gestation in an artificial womb. Without pregnancy, the mother’s greater causal role in the creation of the child would be eliminated. As a result, the importance of biological reproduction would seem to reside in each parent’s genetic contribution and the implantation of a fertilized embryo, as opposed to the labor involved in gestation. Given that each biological parent contributes a complementary gamete which join together to form the fertilized embryo, the causal role of each parent is equal. Presumably, it follows that each parent’s claim to the child would be equal. In this paper, I will extend Norvin Richards (2010) line of argument that the right to parent one’s biological child is a unique kind of liberty right. The genetic contribution of each biological parent plays a necessary role in causing the child to exist, and once the fertilized embryo is implanted, both biological parents can be considered to have begun the project of parenthood. Thus, implantation of a fertilized embryo is the moment at which parents can be said to have a right to their biological child. There are several consequences of this view in light of current, and potential, assisted reproductive technologies. With respect to in-vitro fertilization (IVF), a person does not have the right to create, or implant, a fertilized embryo without the consent of the other genetic contributor. Assuming ectogenesis technology were available, each biological parent would have equal claim to an implanted embryo conceived through consensual sexual intercourse. Notably, it follows that a father has the right to request that the mother undergo fetal extraction. More specifically, if a woman is pregnant but is unwilling to be a parent, she would be obligated to have the fetus removed from her body and placed in an artificial womb in light of the father’s right to his biological child. While a biological parent has the choice to opt-out of being a social parent to the child, the decision to do so does not forfeit the other biological parent’s right to rear the child.

Zinhle Mncube (University of Johannesburg) - Racial categories are widely used in biomedicine. Epidemiologists stratify health outcomes according to racial categories. Pharmaceutical companies develop so-called ‘race-based medicines’ targeted at people of specific racial categories. In clinical practice, doctors consider an individual’s race in testing for certain diseases and for prescribing treatment. Critics of the use of racial categories in biomedicine argue that: (i) race is a non-scientific concept; (ii) racial categories are a bad proxy for genetic variation in human population groups; (iii) the use of racial categories in medicine essentializes and reifies race; and (iv) the use of racial categories can engender bad consequences for patients (for example, it is possible that a treatment held for “white” patients could work on a “black” patient. However, the argument goes, if racial categories are used in the prescribing of drugs, the black patient might not get the treatment that would work for her). My aim in this paper is to address the following epistemological question: is the use of self-identified racial categories as a proxy for differences in medically-relevant risk factors (genetic, and/or social and environmental) warranted in biomedicine? That is, is there warrant for this use of racial categories if the goal is to elucidate the risk factors involved in differences in therapeutic drug response and treatment between people? My claim is that there is an evidential basis for including self-identified racial categories in biomedicine — although crude, racial categories can provide valuable information about variation in the genetic, social and environmental risk factors involved in therapeutic drug response and treatment. I argue that the use of self-identified racial categories is warranted in biomedical research and practice, because, in relevant cases, it works.

M. A. Hunter (University of California, Davis) - In this paper, I highlight an incredibly important issue for epidemiology and the attempt to assess and mitigate population-level health disparities. Populations are taken as the bearers of health-related properties, and are routinely stratified by race or ethnicity. Contemporary use of these categories is slightly worrisome, given that there seems to be no definition of “race” or “ethnicity” that is standard across the discipline. Couple this with one of a recent number of published articles asking either for clarification or outright elimination of the term “race” from biomedical research (Yudell et al. 2016) and it appears that the issues regarding race have been fully illuminated. However, there has been one aspect of this debate that is of special importance to philosophers of medicine, epidemiologists, public health advocates, and biomedical researchers. If we take populations to be the bearers of health-related properties, and we take it that there are racial populations of human beings, then (A) how, exactly, can we say anything true about populations in the past where the racial categories were radically different or did not exist; and (B) how are we to assess population-level health disparities for communities that are future-based but that currently do not exist (i.e., “MENA”)? The structure of my paper is the following: First, I will survey some of the epidemiological literature to highlight ways in which race is treated and defined. Secondly, I will review recent publications that have argued for clarifying or outright removal of the term race from biomedical research. Third, I will introduce two important problems for epidemiological research that have not been previously discussed — the inability to deal with historical racial populations and the looming prospect of dealing with new racial populations. Finally, I will offer a solution to both of the issues at hand — taking an instrumentalist approach to racial populations in epidemiology — and will conclude with a sketch of how my proposed solution could be deployed for empirical research.