American orthodox medicine consolidated its professional authority in the early 20th Century on the basis of its unbiased scientific method. The centerpiece of such a method is a strategy for identifying truly effective new therapies, i.e., the randomized clinical trial (RCT). A crucial component of the RCT in illnesses without established treatment is the placebo control. Placebo effects must be identified and distinguished from pharmacological effects because placebos produce actual but unexplained therapeutic successes. The blinding necessary for a proper placebo-controlled (...) RCT therefore introduces an epistemic bias into orthodox medicine: therapeutic successes that rely upon a direct link between knowing and healing, such as placebo effects, are discarded in favor of therapeutic successes that rely upon an indirect link between knowing and healing, such as pharmacological interventions. Where the capacity to produce therapeutic results once validated the method of clinical medical science, now method validates results. The clinical consequences of this method of testing therapies include a diminished vision of the therapeutic potential of the doctor-patient relationship and of the potential human resources available for healing. Keywords: doctor-patient relationship, epistemology, placebo effect, professionalization, randomized clinical trials CiteULike Connotea Del.icio.us What's this? (shrink)

SummaryCertain revolutionary changes in medicine—measurement, chemistry, genetics—have led to recasting both the criteriology and the conceptualization of the terms of discourse. But advances along this path rest no longer on naive observation but intimately and inextricably involve modeling, that is, a system of inference which derives no immediate warrant from the primordial data of the senses. This system is not totally new in quality, since all “fact” involves interpretation of data; nor is it entirely new in having heuristic value in (...) unearthing, or calling attention to, unsuspected evidence. But it differs in two major respects. First, it requires patterns of surmise which can no longer be immediately corroborated at all stages by naive means but rest more and more on internal theoretical consistency and confirmatory predictions to be verified by other sophisticated and indirect means. Second, it is leading to fundamental upheavals in even the broad perception of human biology, undermining well-established groupings and exposing certain classical fields of inquiry as meaningless. The problem yet to be confronted in this field is how an epistemology of the model (in this sense) is to be constructed. The model is useless (as the whole scientific endeavor is useless) if it has not a more economical structure than the totality of the raw data, even if the success of this economy is in some degree factitious (“robustness”). On the other hand, the model is also useless unless it has heuristic value and helps in adjudicating among competing interpretations (“power”). A good model will help also to distinguish relevant aspects of the data from the irrelevancies ascribed to error. The paradigmatic function of the model, then, defines certain “sufficient statistics” which condense the relevant features of the data. In fact a close analogy can be developed between the methodology of statistical inference and nosology. Both are necessarily tentative, and healthy development of both, in practice, is iterative; that is, the evidence and the model are mutually correcting and lead to advancement one of another. (shrink)

CHAPTER I INTRODUCTION (A) Historical Problem Suggested by the Nature of Modern Thought How curious, after all, is the way in which we moderns think about ...

Thomas S. Kuhn's classic book is now available with a new index.

A less analytic and more wholistic approach to philosophy, described as best overall fit or seeing how things all hang together, is defended in recent works by John Rawls and Richard Rorty and can usefully be applied to problems in philosophy of medicine. Looking at sickness and its impact upon the person as a central problem for philosophy of medicine, this approach discourages a search for necessary and sufficient conditions for being sick, and instead encourages a listing of true and (...) interesting observations about sickness which reflect the convergence of a number of different viewpoints. Among the relevant viewpoints are other humanities disciplines besides philosophy and the social sciences. Literature, in particular, provides insights into the meaning and the uniqueness of episodes of sickness in a way that philosophers may otherwise fail to grasp. (shrink)

My thesis is that, although medicine is scientific, it is not and can not become a science. After rejecting as flawed an argument attempting to show that medicine is already a science, I argue that a comparison of such basic, defining features as internal aims, criteria of success, and principles regulating the enterprises demonstrate that medicine and science are inherently different. I then argue that while it may be possible to reduce the cognitive content of medicine to biology, medicine itself (...) cannot be reduced, for as an enterprise it possesses features that make it an inappropriate subject of reduction. I conclude by indicating four results that emerge from recognizing that medicine and science are basically distinct. CiteULike Connotea Del.icio.us What's this? (shrink)

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as (...) to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. (shrink)

are often used loosely – especially in medical contexts. In an attempt to remedy this, these terms are explored from the standpoints of: philosophy of science, medicine, genetics, history of genetics and clinical genetics. A sense for ‘reductionism’ is developed in part by focusing on the related histories of classical genetics and clinical genetics. This done, the dichotomy between holism and reductionism, whether in basic genetics or the genetic counseling situation, loses much of its force. CiteULike Connotea Del.icio.us What's this?

The basic premise of today's scientific medicine is that the ‘book of man’ is written in the language of the biological sciences, ultimately molecular genetics and biochemistry. The patient is a complex biological organism and disease is a deviation from the norm of somatic parameters. At the same time, many major contemporary diseases are reported to have psychosocial and environmental components in their etiology. Hence the challenge: how can a medical model be both scientific and conceptually well-suited to today's disease (...) burden? I argue that certain contemporary "postmodern" sciences support alternative, non-reductionist (self-organizational) premises. So doing, they offer an infrastructure for a medical model at once scientific and responsive to the diseases at hand. Keywords: biomedicine (biological medicine), natural science paradigm, Cartesian dualism, self-organization, postmodern sciences, self-referentiality CiteULike Connotea Del.icio.us What's this? (shrink)

The observed complexity of nature is often attributed to an intrinsic propensity of matter to self-organize under certain (e.g., dissipative) conditions. In order better to understand and test this vague thesis, we define complexity as “logical depth,” a notion based on algorithmic information and computational time complexity. Informally, logical depth is the number of steps in the deductive or causal path connecting a thing with its plausible origin. We then assess the effects of dissipation, noise, and spatial and other symmetries (...) of the initial conditions and equations of motion on the asymptotic complexity-generating abilities of statistical-mechanical model systems. We concentrate on discrete, spatially-homogeneous, locally-interacting systems such as kinetic Ising models and cellular automata. (shrink)