Philosophy of Medicine Roundtable 2025 (part two)

This is a brief report of some of the talks delivered on the second day of the Philosophy of Medicine Roundtable hosted by King's College London in June 2025. For a report of day one, please go here.

From the poster of the Roundtable

The second day of the event started with a presentation by Devora Shapiro on the role of EBM (evidence-based medicine) in enabling phenomena such as medical gaslighting and illness invalidation. Shapiro discussed cases where patients are told that there are no medical issues for them, because the test results come back with no indication of pathology, and yet the patient has a complaint that matters to them and is not given sufficient uptake.

A slide of Shapiro's presentation

The discussion following the presentation centred on what causes the problems of power-imbalanced relationships between doctors and patients, whether it is EBM or something else, for instance a failure to provide care or a lack of recognition that, although successful, medicine cannot tackle all human problems.

In one of the several talks by project EPIC members at the Roundtable, Elisabetta Lalumera asked why definitions matter in medicine and how linguistic labels function as operational tools. Conceptual engineering and conceptual choice may serve various goals such as diagnostic utility and inclusivity. One example of the importance of definitions is the change in the definition of pain, which has been revised in 2020 to include the sensations of those who cannot describe pain such as infants, nonverbal patients and animals.

Elisabetta Lalumera on definitions of pain

Such revision was motivated by inclusivity and ethical concerns so it was a deliberate value-laden choice. The new definition has the merit of avoiding the risk of epistemic injustice (e.g. when a patient claims to be in pain but no lesion is found) but has risks as well, being more vague, more difficult to operationalise, and likely leading to overmedicalisation of human experience.

In the next talk, Kathleen Murphy-Hollies, postdoc on project EPIC, presented a talk about what it means to give uptake to the metaphorical meaning of delusions. Murphy-Hollies started talking about the experience of entomologists being contacted by people with delusions of parasitosis claiming that they are suffering from an infestation. How should entomologists deal with these cases? To what extent should they believe the people claiming an infestation?

Each testimony has two aspects: the propositional content conveyed and the perspective conveyed in the statement. We can fail to believe what the person says and yet take their perspective seriously. Maybe delusions express metaphorical meaning that is worth trying to understand. Murphy-Hollies builds on account by Federico Bongiorno and Rosa Ritunnano to explore the metaphorical interpretation of delusional utterances.

Kathleen Murphy-Hollies on delusions

In the rest of the talk, Murphy-Hollies observed how metaphorical meaning is not just relevant to people reporting delusional beliefs, but is often conveyed in cases of reports by people who experienced trauma or have implicit knowledge. This observations lead to a new understanding of uptake which is not just believing what the person is saying but is about mutual engagement.

Dan Degerman talked about the medicalisation of silence. Silence has been seen as a cause of depression (not talking about something might lead someone to become depressed), as a symptom of depression (it appears in the criteria for depression), as a problem in the workplace (underperforming) and as a cause and symptom of depression in that context.

Dan Degerman on silence

Degerman asks why the medicalisation of silence is a worry. Silence is a diagnostic marker for depression and can be associated with distress. But by medicalising silence we represent it as a threat, we end up avoiding it, and we obscure its benefits:

• social benefits
• epistemic benefits
• medical benefits.

More important, we may override the benefits of silence for medical or health-related reasons.

As hopefully shown by these remarks on some of the talks, the second day of the Philosophy of Medicine Roundtable was very rich and addressed a variety of issues in the metaphysics, epistemology, and ethics of medicine.

Philosophy of Medicine Roundtable 2025 (part one)

The Philosophy of Medicine Roundtable was held at King's College London on 2nd and 3rd June 2025. Here is a brief account of some of the talks and posters presented on the first day of the event.

Bush House in London, conference venue

The first talk was by John Ioannidis, "Research results: the false, the fake, the useless, and the untouchables". The presentation started with the statement that "Science is the best thing that can happen to humans". Yet, Ioannidis argued that most scientific research has used non-reproducible and sub-optimal research practices.

Results can be:

• False = due to random error or bias
• Fake = not real, crafted, fabricated
• Useless = not having a meaningful purpose
• Untouchable = impossible to access or use.

John Ioannidis

Problems:

• Megajournals publish too many papers and have high acceptance rates (25-60%). Review is fast and authors pay to publish.
• Predatory journals publish poor science and have an acceptance rate of 100%.
• Extreme publishing behaviour is another threat (researchers publish 60 research articles every year) and get high citation rates in problematic ways.
• Many fake papers are generated through AI and only a few are detected and retracted.

In the rest of the presentation, Ioannidis analysed in more detail the challenges of doing science in a way that produces results that are not fake, not useless, and accessible; and suggested some ways we can improve scientific practices.

In the first break of the conference, participants were invited to look at the research posters. One of these posters was by EPIC postdoctoral researcher Jodie Russell. Russell's work is on intersectional invisibility. You can download her poster here.

Jodie Russell on intersectionality

In the afternoon,  Maria Cristina Amoretti presented a paper about the distinction between values and biases in medicine, co-authored with Elisabetta Lalumera. While values guide research priorities and clinical decision-making, biases are typically seen as distortions to be eliminated. However, this view is too simplistic: both values and biases can promote or hinder medical knowledge and patient care. 

Cristina Amoretti and... Pimpa!

Amoretti and Lalumera proposed a functional distinction: values are explicit, discussable, and justifiable judgments shaping medical aims, whereas biases are implicit tendencies influencing reasoning in ways not explicitly articulable. Values are not always beneficial, and biases are not always harmful. Instead, their roles in medical research and clinical practice need further examination.

In another talk, Elena Popa and Jay Zameska discussed the relationship between social determinants of health and various conceptions of causation. The empirical evidence linking wide social issues such as inequality or poverty to health outcomes justifies the search for interventions on these high-level phenomena. This can be a more efficient way of improving the health of a population in contrast with targeting individuals suffering from downstream health effects. 

Elena Popa presenting

But it is difficult to fit insights from population health science with biomedical approaches which focus on downstream causes and which have been preponderantly used in public health. For Pola and Zameska, overcoming the dominance of narrow biomedical models requires considering a wider range of causal concepts, particularly mechanistic and dispositional ones. The suitability of these concepts can then be assessed by analyzing the interventions resulting from them through the lens of priorities in public health

ethics.

Another break in the conference meant another look at the posters! Themistoklis Pantazakos prepared a poster on the role of biomarkers in debates about pathologization.

Themistoklis Pantazakos on biomarkers

Rebecca Brione presented on the importance of philosophy of language for doctor-patient interactions. In particular, Brione focused on failed refusals of medical treatment. Should the patient have the right to refuse treatment, and if so, under what circumstances? Little attention has been paid to the speech act of refusal itself. 

Brione argued that philosophy of language offers the resources we need to develop a more sophisticated understanding of medical refusal (and similar speech acts), in isolation and in context. These resources enable us both to conceptualise refusal as a normative act, and to understand what is required for a patient to succeed in their attempt to refuse treatment. 

Rebecca Brione on medical refusal

Brione presented a novel account of refusal as an assertion which attempts to add both a direct proposition and presupposed content about the normative landscape to the communicative common ground (the shared beliefs, knowledge and information that form the background for an assumed-collaborative conversation).

The first day of the Roundtable was very rich and thought-provoking, showcasing the variety of issues that can be tackled by philosophers of medicine.

Epistemic Injustice in Diagnosis

In this post Lisa Bortolotti interviews Anke Bueter (principal investigator) and Thor Hennelund Nielsen (post-doctoral researcher) on their exciting project, “Epistemic Injustice in Diagnosis” (January 2024 – December 2025) funded by a Starting Grant of the Aarhus University Research Foundation. 

Aarhus University, credit Lars Kruse / AU Foto

Lisa: How did you become interested in this project?

Anke: This project brings together my research interests in feminist epistemology and the philosophy of medicine and psychiatry.  It focuses specifically on diagnosis, as diagnosis is both a prerequisite of successful medical treatments and susceptible to pathocentric epistemic injustices. I wanted to further explore this area after working on the phenomenon of diagnostic overshadowing, in which a previous psychiatric diagnosis leads to diagnostic delays or missed diagnoses regarding somatic diseases (Bueter 2023).

Thor: Diagnostic practices in both somatic medicine and psychiatry – their internal reasonings and capacities to change peoples’ lives for better or worse – have always interested me academically and personally. I’ve been very fortunate that this project allows me to fulfil this interest through investigating the topic of overdiagnosis.

Lisa: What are your objectives and why do you think it is important to achieve them?

Anke: My primary interest lies in avoidable diagnostic errors, which are estimated to affect 10-20% of all medical cases. The project seeks to rethink diagnosis as an (ideally) collaborative epistemic process and to explore how epistemic injustices can hinder this process. For example, I am currently examining gender biases in psychiatric diagnostic criteria, as well as the important role of trust between patients and clinicians.

Thor: Studies within the field have tended to focus on either epistemic injustices of/leading to under- or misdiagnosis but haven’t paid particularly close attention to overdiagnosis, though the epistemic harms of the latter may be equally serious. I want to show that overdiagnosis is not just a problem in terms of iatrogenic harms or lost opportunity costs but also because it fundamentally affects the overdiagnosed patient’s ability to understand themselves and be understood by others.

Lisa: Does your project involve interdisciplinary or crossdisciplinary work? If so, what disciplines are involved?

Thor: The issue of overdiagnosis is crossdisciplinary at heart. The problem itself derives from medicine but is often studied through sociological methods and additionally calls for philosophical scrutiny to elucidate the concepts themselves and the injustices they may create.

Lisa: What do you expect will be the impact of your project, within philosophy and beyond it?

Anke: A better understanding of how epistemic injustice affects diagnosis, and of the mechanisms behind these issues, is a crucial first step toward mitigation. Beyond contributing to the philosophical discussion, we aim to raise awareness among the public and medical professionals about the need for epistemic justice in health care.

Thor: The ambition is to put overdiagnosis on the map within the epistemic injustice in healthcare discussion, and, conversely, open the concept of epistemic injustice to the medical debate on overdiagnosis. Hopefully this contributes to reducing the epistemic harms of overdiagnosis in the “real world” in the long run.

Anke Bueter is Associate Professor of Philosophy in the School of Culture and Society, Aarhus University. Anke is the author of Feminist Philosophy of Science (Cambridge University Press, 2024).

Thor Hennelund Nielsen is postdoctoral researcher in the School of Culture and Society, Aarhus University. Thor is the author of "The Dynamics of Disease: Toward a Processual Theory of Health", an article published in the Journal of Medicine and Philosophy in 2024.

Eleanor Byrne joins EPIC!

Eleanor Byrne will join project EPIC in 2024 as a research fellow in the Philosophy Department at the University of Birmingham. Here she tells us about her research and her interest in epistemic injustice.

Ellie Byrne

Hi Ellie! What are your main research interests?

Hi! I’m a philosopher working mainly in the philosophy of medicine and psychiatry. Within this, I focus primarily on the emotions and the types of medical conditions where there appear to be strong affective components that are not very well understood. 

My PhD focused on fatigue syndromes, and my first postdoc in Sweden focused on Long Covid. I have since been working a little bit on non-epileptic seizures. This understanding gap about the affective lives of patients relates to a host of scientific and social issues which I seek to unpick philosophically. 

Often with tools from phenomenology and the enactivist tradition under my arm, I try to develop a more complex and dynamic framework for understanding the emotions in medicine. My first explicit attempt at that can be found here. I also do a little bit of work on grief, emotion regulation and narrative.

Why do you think it is important to study epistemic injustice in healthcare?

A consistent theme in my own research is how lack of understanding about the emotions in illness causes a significant epistemic burden for patients. For instance, Long Covid patients with anxiety and depression symptoms are often stuck trying to arbitrate between competing explanations about what causes their symptoms, which nonetheless do not seem fully satisfactory. Uncertainty and confusion about one’s emotional life also brings challenges for one’s self-concept: is this the virus or is it me? Who am I now? This epistemic burden relates to all manner of epistemic injustices in healthcare which deserve careful study.

What I find exciting about the study of epistemic injustice in healthcare is how it is progressing: it’s incredibly encouraging to see new distinctions and concepts are coming to fruition that enable us to better capture a subtle dynamic or problem that has long caused significant harm and suffering. I think there is remarkable ameliorative potential, as well as philosophical interest, in the study of epistemic injustice in healthcare.

What are you working on right now?

I’m currently working on a newer concept intricately connected to epistemic injustice: affective injustice. These are injustices that relate to how a persons’s emotions are given (or denied) uptake by others. Uptake failures generally reflect credibility deficits. For instance, the anger of a woman will be given less uptake than the anger of a man because being a woman affords her less credibility.

I am developing a framework of affective injustice that is sensitive to not only discrete emotions like anger, but also to longer-term and diffuse affective experiences like moods, malaises and existential feelings. These affective experiences are common in illness, and failures to give such experiences uptake is responsible for a significant amount of suffering, alienation, shame and self-concept distress. I hope that this work can be a useful part of the wider project goal to develop ameliorative strategies for epistemic injustices in healthcare.