New Directions in Philosophy of Medicine

T he absence of widespread agreement concerning the best conceptual frameworks and most practical clinical approaches in integrative medicine reflects important unresolved philosophical problems about the nature of health and illness. It is only through the analysis of philosophical problems related to observation, evidence, and causality in medicine that development of a rigorous methodology for clinical integrative medicine will evolve. This 4-part paper begins with a brief review of Western medicine's philosophical origins, which I further develop in part II to examine the beginnings of non-Western systems of medicine. I explore the significance of the resulting "philosophical gap," arguing that "ways of seeing" illness and health phenomena are embedded in various systems of medicine that are based on incongruent core metaphysical assumptions. These differences occur because all systems of medicine continuously evolve in the broader context of social, technological, and economic influences. In the third and fourth parts of this paper, I discuss divergent meanings of evidence in disparate systems of medicine and review unresolved philosophical problems in psychiatric classification and diagnosis. Important ontological questions pertaining to medical philosophy are discussed, exploring the point that, for many established conventional or non-conventional approaches, a determination of the existence of a postulated mechanism of action cannot be made in the framework of orthodox Western science on the basis of information obtained using established methodologies and contemporary technologies. I argue that while claims of mechanism can be verified for relatively few conventional and non-conventional medical approaches, claims of effectiveness with respect to a specified symptom or illness can be verified only for a particular approach employed in a specified system of medicine. I conclude that most contemporary biomedical and non-conventional approaches are maintained through expert consensus, but are not currently empirically verifiable according to rigorous scientific standards of evidence. Thus, in many cases selecting an appropriate clinical method when addressing a specified illness requires judgments other than the empirical verification of a putative mechanism of action.

The philosophy of science: A companion, 2018

This chapter views philosophy of medicine as a domain within philosophy of science as opposed to a province of bioethics. Thus, it first deals with the philosophical analysis of health, disease, and illness concepts and with the scientific nature of medicine. Relative to the second theme, it addresses questions relative to the causes and explanations of disease and the status of theories in biomedical science. A central concern here is the status and nature of proof in medicine and the relationship between theory and practice at the heart of evidence-based medicine. Finally, the chapter focuses on the specific problems raised by causal analysis and experimentation in medicine and on the nature of clinical reasoning.

Philosophy of Science, 2022

Is philosophy of medicine a subfield of philosophy of science? Of philosophy of biology? Should it overlap with bioethics? Or is it its own field like philosophy of technology or philosophy of law? Should we worry about the reliability of medical knowledge? With such questions in mind, I briefly review three books in the philosophy of medicine: an introductory survey by R. Paul Thompson and Ross E.G. Upshur, a philosophical critique of medicine by Jacob Stegenga, and a breast cancer survivor's bid for philosophical consolation by Mary Ann Cutter. To philosophers of science, Thompson and Upshur's and Stegenga's contributions will be recognizable as an application of the tools of philosophy of science to medicine. Cutter's book comes from a different tradition, traceable to the philosophy of medicine of Tristram Engelhardt. Thus, while the nature and reliability of medical knowledge takes up most of this review, the issue of demarcation-what philosophy of medicine is and how it relates to philosophy of science, bioethics, and perhaps social and political philosophy-is raised just by virtue of the variety in the books reviewed. In my view, philosophy of medicine should be aware of its relationship to these other fields of philosophy and draw upon them. Thompson and Upshur's Philosophy of Medicine: An Introduction goes well beyond offering a survey of issues in the field. Distinguishing between bench medicine (experimental research and model-building closely allied to biology, chemistry, and physics) and clinical medicine (13), their core thesis-introduced early with contrasting capsule summaries of James Lind's 1753 discovery of the cure for scurvy (6) and Victor Bolie's 1960 glucose-insulin model (7)-is that the mathematical and mechanistic

Dialectica, 2018

Philosophy of medicine has become mainstream in both medicine and philosophy in the last few decades. Thus, it is timely to publish a compendium of philosophy of medicine papers, particularly to summarize lessons learned, assess the current state-of-the-art, and address future needs, including challenges and opportunities. Indeed, in the last year or so, at least two other edited books in philosophy of medicine have been published (Solomon et al. 2016; Schramme and Edwards 2017), in addition to Marcum's book that I review here; to my knowledge, they address similar topics. Hopefully, a comparative review of all three books will be published, as comparison is arguably necessary for rigorous inquiry (Rudnick 2014). Marcum's book is a fairly comprehensive compendium of lessons learned in philosophy of medicine with a particular emphasis on epistemology and metaphysics/ontology, and less so on ethics, which is reasonable considering that medical ethics/bioethics has been profusely covered in other books for a while now. In particular, throughout much if not most or all of this book, the distinction between medicine as science and medicine as art, or similarly between medical scientism and medical humanism, is addressed as an important matter. Indeed, this distinction is highlighted in Marcum's introduction (chapter 1), in Tauber's philosophical and historical survey of medical humanism (chapter 7), and in other chapters. The book is composed (in order of appearance) of Notes on Contributors, 14 chapters, and Research Resources. The 14 chapters are divided into two parts: Introduction (consisting of Macrum's Introductory chapter and of a chapter titled "Research Problems and Methods in the Philosophy of Medicine"), and Current Research and Future Directions (with chapters addressing topics ranging from genomics and molecular biology through epidemiology and evidence-based medicine to medical humanism, phenomenology, gender, person-centeredness, health and disease, causation, clinical reasoning, and new directions).

Journal of Evaluation in Clinical Practice, 2014

2007

This article, the last in a 4-part series on philosophical problems in conventional and integrative medicine, focuses on problems related to deriving methodologies for identifying integrative assessment and treatment approaches. Methodologies used to verify claims made for a particular conventional or nonconventional approach can be regarded as empirically derived, consensus-based, or intuitive. I show that conventional and non-conventional approaches are equivalent in terms of verifiability when a postulated mechanism of action cannot be empirically validated but replicable positive outcomes are confirmed. The broad philosophical problem of evidence in medicine can be reframed as the problem of deriving a methodology for determining criteria that can be used to verify assessment specificity or treatment effectiveness in relation to claims of outcomes associated with a particular modality. The conceptual basis of integrative medicine cannot be derived from first principles through a...

Dialectica, 2009

Perspectives in Biology and Medicine, 1987

Of central concern to the philosophy of medicine is an understanding of the relationship that arises between science and ethics when decisions involve human beings. To examine this relationship, we must consider the status of claims to medical knowledge and whether there exists within medical practice a style of collecting and analyzing data and making therapeutic decisions that is properly called science. Since ideally, in medicine, knowledge guides practice, to a significant extent our factual claims will legislate our behavior toward our fellowman. Clearly, other considerations compete with science for influence over medical decisions-for example, law, custom, patient preferences, convenience. However, without a "science of clinical medicine" and without a clear understanding of how we distinguish between valid and invalid factual claims, medical opinion loses much of its moral force. These introductory remarks reflect a belief that a clinical science does indeed exist. This view of medicine is not universally shared, and an examination of this assumption will be the primary task of the first two sections of this essay. There I will briefly survey well-known material in the phUosophy and history of science and attempt to demonstrate the scientific status of good clinical thought. This is followed by a discussion of the concept of reasonableness in medical decision making. It is this further concept that links science to practice, ultimately raising a variety of ethical issues. The concluding section explores more specifically the intimate link between clinical science and ethics, both the ethical demands created by science and the need to structure scientific work so as to be consonant with our moral perspectives.