Over the last decade, philosophers of science have extensively criticized the epistemic superiority of randomized controlled trials for testing safety and effectiveness of new drugs, defending instead various forms of evidential pluralism. We argue that scientific methods in regulatory decision-making cannot be assessed in epistemic terms only: there are costs involved. Drawing on the legal distinction between rules and standards, we show that drug regulation based on evidential pluralism has much higher costs than our current RCT-based system. We analyze these (...) costs and advocate for evaluating any scheme for drug regulatory tests in terms of concrete empirical benchmarks, like the error rates of regulatory decisions. (shrink)

This contribution explores how Forrester’s work on cases has opened up an arena that might be called ‘the medical case as a travelling genre’. Although usually focused on the course of disease in an individual patient and authored mostly by one medical author, medical case histories have a social dimension: Once published, they often circulate in networks of scholars. Moreover, scholars of the history of literature have shown that numerous medical cases seem to travel easily beyond the context of medical (...) science into the realm of popular literature and journalism. After tracing the idea of cases travelling in Forrester’s Thinking in Cases, I discuss several contributions by authors who, in the wake of interdisciplinary research on cases in the past two decades, have dealt in different ways with this idea. In the third section, I present my own research on a case of self-crucifixion that was widely discussed in 19th-century Europe. I suggest that understanding the case as a ‘traveling genre’ – an expression borrowed from literary genre theory – highlights the role of readers and publication formats as constitutive for cases, and enables us to see more clearly what cases do for scientists and writers who work with them. (shrink)

In some quarters within philosophy of medicine, more particularly in the phenomenological approaches, naturalism is looked upon with suspicion. This paper argues, first, that it is necessary to distinguish between two expressions of this attitude towards naturalism: phenomenological approaches to illness disagree with naturalism regarding various theoretical claims and they disapprove of naturalism on an ethical level. Second, this paper argues that both the disagreement with and the disapproval of naturalism are to a large extent confused. It then offers some (...) proposals to set up an agenda for future collaboration. (shrink)

The first part of a symposium devoted to Alex Broadbent's essay titled ‘Prediction, Understanding and Medicine’, this article notes the under-development of a variety of issues in the philosophy of medicine that transcend bioethics and the long-standing debates about the nature of health/illness and of evidence-based medicine. It also indicates the importance of drawing on non-Western, and particularly African, traditions in addressing these largely metaphysical and epistemological matters.

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

Der Krankheitsbegriff ist sowohl ein Begriff der Lebenswelt als auch ein theoretischer Begriff der medizinischen Wissenschaft. Das Paper zeigt die wichtigsten Unterschiede auf. Im ersten Teil wird die Grundstruktur der Krankheitslehre anhand von 7 Prinzipien dargestellt. Im zweiten Teil werden einige besonders wichtige Unterschiede in Form von Frage und Antwort explizit erklärt. Prinzipien: Die Krankheitslehre hat das individuelle menschliche Leben unter dem Aspekt von Krankheit und Gesundheit zum Gegenstand. Die Krankheitslehre fasst Krankheiten als abgrenzbare Anteile eines individuellen Lebens auf. Jedes (...) krankhafte Phänomen ist entweder eine Krankheit oder deren Manifestation. Jede einzelne Krankheit ist ein Fall einer allgemeinen Art: einer Krankheitsentität. Krankheitsentitäten werden definiert durch eine Kombination von Erstursachen, Wirkbedingungen, Reaktionen und Folgen im Organismus, Verlaufsformen und Ausgängen. Krankheitsentitäten sind durch sie definierende pathologische Merkmale gekennzeichnet. Die Pathologizität von Merkmalen lässt sich durch ein System von Krankheitskriterien charakterisieren. Ein fraglich pathologischer Lebensvorgang kann durch Rekurs auf die Ätiopathologie der zugehörigen Krankheitsentität theoretisch eingeordnet werden. Fragen : Gibt es eine scharfe Grenze zwischen Gesundheit und Krankheit? Gibt es zwischen Gesundheit und Krankheit einen neutralen Bereich von Zuständen? Kann die Medizin eine positive Definition von Gesundheit angeben? Kann man Gesundheit mit vollständigem subjektivem Wohlbefinden gleichsetzen? Ist Krankheit etwas Unnatürliches? Können Menschen auch dann gesund sein, wenn sie eine Krankheit oder Behinderung haben? Ist jemand krank, bei dem ein Risikofaktor festgestellt wird? Dürfen gegen eine Krankheit nur Personen mit nachgewiesener Erkrankung behandelt werden? Ist Krankheit immer ein Übel? Welche normativen Implikationen hat der wissenschaftliche Krankheitsbegriff? (shrink)

In this introduction to a special subsection of Theoretical Medicine and Bioethics comprising separate reviews of the Springer Handbook of the Philosophy of Medicine, The Routledge Companion to Philosophy of Medicine, and The Bloomsbury Companion to Contemporary Philosophy of Medicine, I compare the three texts with respect to their overall organization and their approach to the relation between the science and the art of medicine. I then indicate two areas that merit more explicit attention in developing a comprehensive philosophy of (...) medicine going forward: health economics and systematic relations within the field as a whole. The reviews that follow speak for themselves. (shrink)

The phenomenology of medicine is that part of the research field of the philosophy of medicine that asks about the subjective experience of illness. In contrast to the philosophy of medicine, the phenomenological approaches explicitly include medical and bioethical questions as part of their research interests. The paper provides an overview of the most important questions and topics of the phenomenology of medicine. Subsequently I will refer to the fundamental critique articulated by feminist positions in the field of phenomenology of (...) medicine. In addition to the socio-political contextualisation of the experience of illness, this also includes the necessary recourse to empirical research. (shrink)