The concepts of health and disease are notoriously difficult do define. Most problematic is the establishment of an evaluative norm that demarcates diseased from healthy conditions. Since there might be an impairment of organismic functions without subjectively feeling ill, the norm needs to be objective or at least to have an objective component. Quite often, the concepts of health and disease are therefore hooked up to theoretical concepts of function and dysfunction. The norm, then, is usually read from data about what is standard within a population, be the population of present individuals or one of our predecessors during evolutionary processes. Medicine, however, aims increasingly at the diagnosis and treatment of individuals according to their specific physiological needs, which may deviate from average needs. It may even happen that a regulatory state that is a diseased condition for one patient may be perfectly fine for another. Consequently, the concepts of dysfunction and of disease must be reconsidered in the light of the goals of individualized medicine. Population level averages might still be used as indicators for diseased conditions, but they are no longer decisive. The norm for demarcating disease in individualized medicine must itself be individualized.

This dissertation project investigates the potential of various concepts of function and dysfunction to yield a basis for concepts of disease in individualized medicine. Possible candidate concepts for this comparative assessment are the statistical concept of health (Boorse 1977), etiological concepts of proper functions (Millikan 1984 and 1989; Neander 1991), the concept of function as based on the individual design on an organism (Krohs 2009 and 2011), and concepts of function based on systemic closure (Mossio et al. 2009; Saborido et al. 2011).

The project thus inquires into the different options of defining non-collective physiological norms. It seems plausible that this requires a replacement of statistical and population measures by reference to the individual genome and to individual regulatory states. However, the goal of the project is not to develop a homogeneous definition of disease, which will hardly be achievable even in the long run. In contrast, it shall account for the variety of concepts of disease in medicine. The project will have a strong empirical aspect in relating the different theoretical concepts to actual uses of the concept of disease and on the change that is observable in medicine itself on the advent of individualized medicine. It will be run in close collaboration with biologists, bio-informaticians and physicians. By clarifying the relations between the concepts in question it  will help to further develop the conceptual basis of individualized medicine.

References

Boorse, C. (1977) Health as a theoretical concept. Philosophy of Science 44, 542-573.

Krohs, U. (2009) Functions as based on a concept of general design. Synthese, 166, 69–89.

Krohs U. (2011) Functions and fixed types: Biological and other functions in the post-adaptationist era. Applied Ontology 6, 125–139.

Millikan, R.G. (1984). Language, Thought, and Other Biological Categories: New Foundations for Realism. Cambridge, MA:MIT Press.


Millikan, R.G. (1989). In defense of proper functions. Philosophy of Science, 56, 288–302.

Mossio, M., Saborido, C. and Moreno, A. (2009). An organizational account of biological functions. The British Journal for the Philosophy of Science, 60, 813–841.

Neander, K. (1991). Functions as selected effects: the conceptuals analyst’s defense. Philosophy of Science, 56, 168–184.

Saborido, C. Mossio, M. and Moreno, A. (2011). Biological Organization and Cross-Generation Functions. The British Journal for the Philosophy of Science, 62, 583-606.

Münster: Münster Graduate School of Evolution (MGSE)