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

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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.
Original languageEnglish
Pages (from-to)128-146
Number of pages19
JournalJournal of Medicine and Philosophy
Volume49
Issue number2
Early online date28 Feb 2024
DOIs
Publication statusPublished - 1 Apr 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of the Journal of Medicine and Philosophy Inc.

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