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Projects + Publications
A Risk-Informed Concept of Disease: a tool for medicine. Mefisto Journal of Medicine, Philosophy, and History 2025 9(1):71-92. DOI: 10.4454/mefisto.9-1.1424
Abstract: To determine what defines the concept of disease and whether that concept is value laden, some authors (Lemoine 2013; 2015) advocate for an inductive approach. Lemoine argues that this examination should avoid considering value-laden disease judgments by looking at scientific descriptions of disease. I examine what medicine considers a scientific description of disease, finding that diseases are increasingly described in terms of risk. But in the face of uncertainty about what level of risk constitutes disease, decision-makers turn to non-epistemic values, like economic payoffs of diagnosis, to establish a biological threshold of risk which determines where a biological variable counts as disease. An inductive examination of diseases described in terms of risk results in a concept of disease that is not value-free. This historically informed examination of the concept of disease demonstrates that the concept is a tool which is sculpted by specific actors to serve the goals of diagnosis.
Into the Valley of the Sick New England Journal of Medicine 2025 393(5): 421-423. DOI: 10.1056/nejmp2500755
Abstract: With her Cushing’s disease in remission, a philosopher of medicine realizes she’s an imposter both in the hospital and outside it, as she lives on the edge of the valley of the sick. But she’s not alone there.
How the Personal Health Device Erases the Symptom (in progress)
Abstract: Chronic diseases are increasingly diagnosed, treated, and understood through risk. Because the pathophysiology of many chronic diseases remains inaccessible to direct intervention, medical practice substitutes risk for cause, orienting treatment toward the mitigation of risk of future organ damage by managing intermediary biomarkers. In type 1 diabetes, for instance, the destruction of pancreatic beta-cells cannot (yet) be reversed or directly intervened on, so the disease is managed by controlling the intermediary biomarker of blood glucose, thereby reducing the patient’s risk of future organ damage. This substitution transforms disease into a temporally extended condition: a mediation between an inaccessible cause and controllable future effects of that cause.
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Recent personal health technologies such as continuous glucose monitors amplify this risk framework by continuously measuring biomarkers, predicting deviations, and allowing for preemptive corrections. Such devices promise the disappearance of symptoms and the minimization of risk, yet they do not eliminate the disease itself. Even under conditions of “perfect control,” the pathogenesis persists. Thus, risk is pragmatic, or a tool used to treat disease rather than an ontology which explains it.
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In this paper, I’ll explore how the personal health device in type one diabetes effectively erases its symptoms. I look at the history of the development of continuous glucose monitors and insulin pumps since the early 1960s in order to trace a narrative about attempts to control risk. As technologies for type one diabetes have evolved, particularly since 2010 with partially closed-loop technology in which data from continuous glucose monitors which predicts glucose trends is used to alter automatic insulin dosages in insulin pumps, the associated symptoms which patients have long used to guide their management of risk have disappeared. Although this is a triumph for diabetics, it is accompanied by conceptual side effects. Erasing the symptoms of diabetes means that patients with type one diabetes experience their disease differently than before, often by way of notification rather than sensory perception.
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As symptoms fade from the experiential landscape, so too does a traditional avenue of patient knowledge. Patients increasingly depend on their devices not only to manage risk but to know when they are sick, when they are stable, and when action is required. Clinicians likewise shift their interpretive and diagnostic authority: device-generated biomarkers are given a new place in diagnostic justification. The result is a new epistemic configuration in which diabetes is known primarily through its risk profile, continuously recalculated by sensors and algorithms. The rise of personal health devices in type 1 diabetes represents a broader transformation in how chronic disease is conceptualized: as something verified by data rather than experienced.
