Analytic philosophy of medicine Sadegh-Zadeh conceived
analytic philosophy of medicine as philosophy of medicine in the
analytic tradition of philosophizing, i.e.,
philosophy of medicine by means of logical and conceptual analysis with its primary fields of inquiry being: • Philosophy of medical language, • Medical
praxiology, i.e., philosophy, methodology and logic of medical practice, •
Medical epistemology, • Medical
deontics, i.e., analysis of medical
morality, obligations, and
law, • Medical
logic, and • Medical
metaphysics.
Philosophy of medical language Sadegh-Zadeh considered medical language an ill-structured and ill-kept extension of everyday language by adding technical terms such as "angina pectoris", "appendicitis", etc. Sadegh-Zadeh claims that most of its terms are imprecise and ambiguous because they are either undefined or ill-defined. Since it has a significant impact both on medical knowledge and medical decision-making, he devotes himself extensively to the analysis of its nature and of its
syntax,
semantics, and
pragmatics. He demonstrates and analyzes what he claims to be the inherent
vagueness of medical terms and constructs techniques for dealing with this principally ineliminable feature by means of
fuzzy logic. To this end, he introduces a comprehensive
methodology of medical, including
fuzzy, concept formation. Inspired by
Patrick Suppes's and
Carl Gustav Hempel's works, he bases this methodology on an
explication and
formalization of all methods of
definition known today.
Medical praxiology Medical, or clinical,
praxiology is an old term introduced by Sadegh-Zadeh in 1977–1981 already to denote a wide-ranging inquiry into the foundations of
clinical practice, particularly of clinical judgment and decision-making, with the aim of reducing diagnostic-therapeutic errors and of improving physician performance. In the latter article referred to, he has defined the term explicitly as "analysis of clinical practice", "inquiry into clinical practice", and "theory of clinical practice", i.e.,
the philosophy, methodology, and logic of medical doing and acting. Central topics include everything related to concepts and theories that are basic to clinical practice, i.e., the concepts and theories of
patient,
suffering,
health,
illness,
disease,
diagnosis,
etiology,
prognosis,
therapy, and
prevention. This perspective, Sadegh-Zadeh claims, creates a fertile scientific field with a host of tasks ranging from conceptual analyses (like "what is
disease?", "what is a diagnosis?", "what is differential diagnosis?", etc.) to logical analyses – such as "is clinical decision-making
computable or does it require human
intelligence and
intuition?" – to
epistemology,
ethics, and
metaphysics of clinical decision-making and so forth. Over the past decades, Sadegh-Zadeh's clinical praxiology has developed further with increasing sophistication. One example of his theories is the
prototype resemblance theory of disease presenting a fuzzy-logical explication of the vague concept of disease:
Medical epistemology Medical
epistemology is the philosophy of medical knowledge or simply
theory of medical knowledge. Sadegh-Zadeh conceived it as a task or branch of the
philosophy of medicine already in 1982 deploring that "The contemporary philosophy of medicine movement is mainly concerned with medical-ethical problems while unduly neglecting medical-epistemological ones". The category
medical knowledge consists of statements of spatio-temporally localized facts, general hypotheses, and theories. Sadegh-Zadeh has proposed an elaborate systematics of all types of medical hypotheses and knowledge the latter ones including classificatory knowledge, causal knowledge, experimental knowledge, theoretical knowledge, practical knowledge, clinical knowledge, and medical metaknowledge. Most important among them is what is called
practical knowledge or
know-how in medicine. By a formally precise explication of this knowledge type he shows that medical-practical knowledge actually consists of conditional norms, i.e., deontic conditionals, mainly
conditional obligations. This is one of the reasons why Sadegh-Zadeh considers medicine a deontic discipline. Specifically, he views clinical practice as
practiced morality because clinical decision-making is nothing but the application of conditional obligations of which diagnostic-therapeutic rules of action primarily consist. And since clinical research pursues such rules of action and tries to improve the available ones, it constitutes
explorative and normative ethics based on empirical research and experience. A central role in Sadegh-Zadeh's medical epistemology play medical theories. He analyzes the concept of "medical theory" in line with the so-called
structuralist view of theories to represent their structure and content, according to
Patrick Suppes and
Joseph D. Sneed's approach, as
set-theoretic predicates. This enables him to show that a theory in medicine cannot be confirmed, supported, disconfirmed, verified or falsified simply because it is merely a
conceptual structure and no
epistemic entity to be true, probable or false. It does not make any empirical claims about the world. Such claims are made
using the theory as a tool. The claims themselves, as empirical hypotheses, are something different than the theory. Not only medical theories, as non-epistemic entities, do not deserve the ascription of truth or falsehood. Regarding any other piece of general medical knowledge, Sadegh-Zadeh shows that apart from the
Gettier problem, it does not fulfill the classical
definition of knowledge as
justified true belief. According to his detailed analysis, there are no justified true beliefs in medicine. Statements, hypotheses and theories in medicine and other fields are usually viewed as knowledge only because the ascription "this is knowledge", for example,
that AIDS is caused by HIV is knowledge, is a performative conducted or affirmed by a scientific or professional community as a
social group. This communitarian and
social epistemology that goes back to the Polish physician and epistemologist
Ludwik Fleck (1896–1961), is profitably utilized and extended by Sadegh-Zadeh.
Medical deontics Apart from the deontic nature of medical-practical knowledge referred to above, a second reason why Sadegh-Zadeh classifies medicine as a deontic field is his view that according to his
prototype resemblance theory of disease, the concept of disease is inherently value-laden. This is so because prototype diseases upon which
nosology is based are, as phenomena,
disvalued by human beings and are therefore considered to be something "that ought not to be". That means that they are, and consequently all other diseases as their resemblants are, deontic entities. The deonticity of medicine and of disease as its basic concept necessitates, according to Sadegh-Zadeh, a specific inquiry by means of suitable tools and methods, i.e.,
deontic logic. This research field he terms
medical deontics. It also includes
medical ethics,
medical metaethics, and
medical law.
Medical logic Publications entitled "The Logic of Medicine" give rise to the question whether medicine has its own logic like
quantum logic is argued to be
the logic of quantum mechanics. To answer the question, Sadegh-Zadeh distinguishes between
logic in medicine and
logic of medicine. "Logic in medicine" means the class of all logics that are, or may be, applied in medicine to solve theoretical or practical problems. Examples are
classical two-valued logic,
many-valued logic,
paraconsistent logic,
deontic logic,
temporal logic,
probability logic,
fuzzy logic, and so on. Their number is unlimited. But none of them is specifically made for medical use. This
logical pluralism in medicine parallels the mathematical pluralism in that innumerable mathematical theories are used in medicine as well without any of them being "the mathematics of medicine". So, there is no
logic of medicine, Sadegh-Zadeh concludes, a logic that could be viewed or used as a specifically medical logic.
Medical metaphysics Medical
metaphysics is primarily concerned with (i) medical
ontology, (ii) medical
truth, and (iii) the nature of medicine. (i) Medical ontology. Sadegh-Zadeh devotes himself extensively to
pure,
formal, and
applied ontology to use them in his logical analysis of medical-ontological issues of
medical knowledge,
clinical practice,
nosology,
psychiatry, psychosomatics, and
biomedicine such as, for example, whether diseases exist or are fictitious entities invented by nosologists and physicians, and whether particular other things such as genes, psyche, and schizophrenia exist or are mere
myths. To settle these enduring controversies and similar ones in medicine, he first distinguishes between
ontology de re and
ontology de dicto. The distinction is based on a syntactic criterion similar to
Barcan formula and enables differentiation between fictional entities such as Sherlock Holmes and real ones. Second, he inaugurates an intriguing fuzzy ontology by introducing a many-place existence
operator and
fuzzyfying this operator to obtain a quantitative concept of existence that he calls the
Heraclitean operator. The Heraclitean operator ranges over the domain of all imaginable entities, including existent, non-existent, and fictitious ones, and over all possible frames of reference, a frame of reference being a particular language and a particular logic. As a result, an entity exists, does not exist, or is fictitious only to a particular extent in the unit interval [0, 1] with respect to a particular language and a particular logic. In this way, ontological stances such as
realism,
anti-realism, and
fictionalism regarding whether something exists or not, become obsolete. For example,
schizophrenia may exist with respect to
Eugen Bleuler (1857–1939) and his followers' language and logic, while
Thomas Szasz and his followers may view it as a
myth with respect to their language and logic. The only remedy for irreconcilable ontological controversies of this and similar type is to care about one's unkempt language and logic, and to reach an agreement about which language and conceptual system and which logic should be used in a particular scientific discourse. Anyhow, medical language and its sublanguages as ill-structured and ill-kempt workaday languages are absolutely unsuitable for serious discourses. They allow their users too much latitude in interpretation. "Change your language or logic, and you will see another world". His fuzzy ontology also includes a fuzzy
mereology and
mereotopology by means of which vague part-whole relationships, for example in anatomy, surgery and other medical fields, become logically tractable. In addition, he has developed a technique to bring to light the
ontological commitments of any piece of medical knowledge so as to ascertain the ontological prerequisites of its satisfiability. He hopes to have paved the way thereby for a precise medical
model theory in analogy to the mathematical one, which might enable sophisticated
knowledge ontology in medicine and elsewhere, and thus, advanced medical
epistemology. "In such a medical model theory, relationships between models of different items of medical knowledge, including theories, could be precisely analyzed". However, he is very skeptical about what has recently come to be known as
biomedical ontology engineering in biomedical computer and information sciences. He does not regard this endeavor as ontology at all because it is actually concerned with vocabularies and terminologies confirming the slogan "ontology recapitulates philology". (ii) On medical truth. After a thorough discussion of
truth theories, Sadegh-Zadeh shows that there is sufficient evidence to support the assertion that medical truths are system-relative, and are produced within the respective health care systems themselves. They do not mirror or report scientifically discovered facts
in the world out there which could be independent of the conceptual system from where they are viewed and judged. This problem not only concerns truth in medical sciences, but also truth in clinical practice. Specifically, he precisely explicates the concepts of diagnosis, differential diagnosis, and misdiagnosis to demonstrate that the truth and falsehood of all these outcomes of clinical decision-making are relative to the respective medical language and knowledge used, to methods of inquiry applied, to conceptual systems, vocabularies and terminologies constructed and proposed by scientific and professional communities, to regulations issued by health authorities, and to other factors in the health care system that impact on the actions and interactions of the diagnostic personnel. According to Sadegh-Zadeh,
medical truth is made in medicine. (iii) On the nature of medicine. In his
analytic philosophy of medicine, Sadegh-Zadeh places particular emphasis on the analysis of medicine as a scientific field. Abandoning widespread, shallow mono-categorizations such as "medicine is a science" versus "medicine is an art", he demonstrates that in declarations of the type "medicine is such and such", the global term "medicine" should be differentiated to acknowledge that medicine, comprising many heterogeneous disciplines, belongs to a large number of categories. For example, without doubt
biomedicine is
natural science; clinical research, however, is
practical science; it is also
normative ethics; clinical practice is practiced
morality; and so on. What is worth noting, is that medicine is also a
poietic science (from the Greek term ποίησις for "making, creating") that invents, designs, and produces medical devices in the widest sense of the term "making", from drugs to prosthetics to brain chips to artificial organs to artificial babies. Medicine is thus on its way to become an
engineering science, conducted as
health engineering and anthropotechnology.
Applied fuzzy logic The application of
fuzzy set theory and
fuzzy logic to biomedical subjects, clinical problems, and philosophical issues is one of Sadegh-Zadeh's main interests. Prominent among his achievements in this area is the reconstruction of
biopolymers (such as
nucleic acid chains
DNA and
RNA and
polypeptide chains) as ordered
fuzzy sets. This
theory of fuzzy biopolymers has made biopolymers amenable to fuzzy set theory and logic and has proved very fruitful thereby to stimulate research interest in different teams. Other examples are (i) extensive application of fuzzy logic in his clinical praxiology and to problems of clinical decision-making; and (ii)
fuzzification of deontics and
ontology.
Philosophy of technology In his methodology of fuzzy concept formation, Sadegh-Zadeh has introduced a fuzzy concept of self-reproduction, termed
quasiself-reproduction, that has enabled him to interpret the
self-reproducing machines in a completely new way and to suggest a
theory of technoevolution. There is something in the nature of
technology, he says, that we, as human beings, cannot afford to ignore. It is the tendency of machines to join up and to work together to the effect that a larger machine emerges being more efficient and powerful than its parts. This peculiarity has led in the last centuries to the growth of a distributed, unique
Global Machine, GM, which consists of the network of
all machines on and around the earth. How this globalization of the machine could occur and what GM looks like, is reconstructed and explained in his theory. Comparable to the
bioevolution of animal and plant species, the technoevolution proceeds as a Darwinian one by quasiself-reproduction and
selection. GM constitutes a subsystem of a hybrid
hypercycle of two evolving partners,
biosphere and
technosphere, which due to the enormous dynamics of the hypercycle rapidly coevolve. On the part of the technosphere, the salient yield of the coevolution is the advancing
mentalization of GM, a process that human beings misconceive as
artificial intelligence constructed by them. But according to Sadegh-Zadeh's theory, this is only a myopic interpretation of the gradual, natural emergence of the intelligent and self-conscious in the guise of a globally distributed machine. == Selected publications ==