Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density.

IF 1.3 3区 哲学 Q3 ETHICS Journal of Medicine and Philosophy Pub Date : 2024-03-14 DOI:10.1093/jmp/jhae005
Nicholas Binney
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Abstract

Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.

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参考类问题是真实存在的:健康调整参考类与低骨质密度。
Elselijn Kingma 认为,克里斯托弗-博尔斯的生物统计学理论(BST)并没有说明它所使用的参考类是如何客观和自然的。最近,医学哲学家们试图反驳 Kingma 的担忧。我认为,这些反驳在理论上缺乏说服力,而且有明显的例子表明,医生会根据他们之前对健康和疾病的了解来调整他们的参照等级。我将重点放在使用年龄调整参考类来诊断儿童骨质密度低的问题上。除了使用 BST 的年龄、性别和物种外,医生还选择使用其他因素来定义参考类别,如青春期状况、骨龄、体型和肌肉质量。我的研究表明,医生会根据他们先前对健康和疾病的了解来校准他们使用的参考类别。参考类的选择也是出于实用的原因,例如预测脆性骨折。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
30
期刊介绍: This bimonthly publication explores the shared themes and concerns of philosophy and the medical sciences. Central issues in medical research and practice have important philosophical dimensions, for, in treating disease and promoting health, medicine involves presuppositions about human goals and values. Conversely, the concerns of philosophy often significantly relate to those of medicine, as philosophers seek to understand the nature of medical knowledge and the human condition in the modern world. In addition, recent developments in medical technology and treatment create moral problems that raise important philosophical questions. The Journal of Medicine and Philosophy aims to provide an ongoing forum for the discussion of such themes and issues.
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