Chapter 1 FROM ORDER TO DISORDER 5 mins. John enters and goes into his office. He says something very quickly about having made a bad mistake. He had sent the review of a paper. . . . The rest of the sentence is inaudible. 5 mins.

With this manifesto, John Dupré systematically attacks the ideal of scientific unity by showing how its underlying assumptions are at odds with the central conclusions of science itself.

In this book van Fraassen develops an alternative to scientific realism by constructing and evaluating three mutually reinforcing theories.

In this sequence of philosophical essays about natural science, the author argues that fundamental explanatory laws, the deepest and most admired successes of modern physics, do not in fact describe regularities that exist in nature. Cartwright draws from many real-life examples to propound a novel distinction: that theoretical entities, and the complex and localized laws that describe them, can be interpreted realistically, but the simple unifying laws of basic theory cannot.

"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for physician, and genesis, meaning origin. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take (...) up increasing space in medical dope-sheets [...] The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers [...] This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal."-- from Introduction. (shrink)

This paper examines the way in which causal relations are understood in the dominant model in contemporary medicine. It argues that the causal relation is not definable in terms of the condition relation, but that in general for conditions of an occurrence to be among its causes they must answer instrumental interests in a certain way, and there are further criteria for distinguishing 'the' cause of a disease (i.e., its etiological agent) from other causal factors, which are based upon instrumental (...) interests peculiar to medicine. It also argues that diseases are complex processes of which both clinical and underlying patho-physiological manifestations are proper parts (as contrasted with effects). (shrink)

What are biological species? Aristotelians and Lockeans agree that they are natural kinds; but, evolutionary theory shows that neither traditional philosophical approach is truly adequate. Recently, Michael Ghiselin and David Hull have argued that species are individuals. This claim is shown to be against the spirit of much modern biology. It is concluded that species are natural kinds of a sort, and that any 'objectivity' they possess comes from their being at the focus of a consilience of inductions.

This book is the one to put into the hands of those who have been over-impressed by Austin 's critics....[Warnock's] brilliant editing puts everybody who is concerned with philosophical problems in his debt.

Inviting a reappraisal of the status of scientific knowledge, Andrew Pickering suggests that scientists are not mere passive observers and reporters of nature.

When first published twenty years ago, The Logic of Medicine presented a new way of thinking about clinical medicine as a scholarly discipline as well as a profession. Since then, advances in research and technology have revolutionized both the practice and theory of medicine. In this new, extensively rewritten edition, Dr. Murphy includes changes to show how these different areas of scholarship may affect details of "the logic of medicine" without compromising its fundamental coherence. New to this edition are discussions (...) of the challenge of the flood of new empirical data, new ideas in genetics, molecular biology, homeostasis, pathogenesis, cancer, aging, and Alzheimer's disease. Murphy also comments on such new theoretical topics as dynamic systems, chaos, and fractals and their impact on the burgeoning fields of philosophy and practice of medicine. Written with medical students in mind, the book includes a glossary, many new examples, and problems for solutions with comments on each. An entirely new chapter deals with modeling. Clinicians and researchers will also find the principles thought-provoking and illuminating. (shrink)

I defend a view of the species category, pluralistic realism, which is designed to do justice to the insights of many different groups of systematists. After arguing that species are sets and not individuals, I proceed to outline briefly some defects of the biological species concept. I draw the general moral that similar shortcomings arise for other popular views of the nature of species. These shortcomings arise because the legitimate interests of biology are diverse, and these diverse interests are reflected (...) in different legitimate approaches to the classification of organisms. In the final section, I show briefly how the pluralistic approach can help to illuminate some areas of biological and philosophical dispute. (shrink)

This 1983 book is a lively and clearly written introduction to the philosophy of natural science, organized around the central theme of scientific realism. It has two parts. 'Representing' deals with the different philosophical accounts of scientific objectivity and the reality of scientific entities. The views of Kuhn, Feyerabend, Lakatos, Putnam, van Fraassen, and others, are all considered. 'Intervening' presents the first sustained treatment of experimental science for many years and uses it to give a new direction to debates about (...) realism. Hacking illustrates how experimentation often has a life independent of theory. He argues that although the philosophical problems of scientific realism can not be resolved when put in terms of theory alone, a sound philosophy of experiment provides compelling grounds for a realistic attitude. A great many scientific examples are described in both parts of the book, which also includes lucid expositions of recent high energy physics and a remarkable chapter on the microscope in cell biology. (shrink)

The germs of the ideas in this book became implanted in me during my experience as a resident in clinical pathology at Boston University Medical Center. At the time, I had inklings that the test results churned out by our laboratories were more than scientific facts. As a philosophically unsophisticated young physician, however, I had no language or framework to analyze what I saw as a deep philosophical problem, a problem largely unrecognized by most physicians. The test results provided by (...) our laboratories were accurate and of great practical importance for patient care. However, most of the physicians who relied on our test results to diagnose and treat their patients either did not have the time or interest to consider the philosophical issues inherent in diagnosis, or, like me, had inadequate means to further analyze them. It was more than ten years later that I began doctoral studies in philosophy, and I was fortunate to find a faculty that was supportive of my efforts to address the problem. This book began as my doctoral dissertation in the Department of Philosophy at Georgetown University. I would like to acknowledge the assistance of my mentor, Robert Veatch, Ph. D. Our conversations during my Georgetown years led me in new and often fascinating directions. I would also like to acknowledge the help of Kenneth Schaffner, M. D., Ph. D. (shrink)

Biological science does not try to distinguish between health and disease. Biology is concerned with the interaction between living organisms and their environment. What we call health or disease is quite irrelevant.These reactions between the individual and his environment are complex. The individual and his surroundings form an integrated system which we can arbitrarily divide into two parts. There is an “external” component, by which we mean such factors as light, heat, percentage of oxygen in the air, quantity of minerals (...) or vitamins in food, micro-organisms in food or air, and so on. These can induce changes in what we arbitrarily call the “internal” component. Here we include such crude factors as anatomical structures, or finer details like composition of intercellular fluid, or secretions of glands, or changes of electrical potential in nerve or muscle. (shrink)

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. Disease (...) can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

Many philosophers and medical scientists assume thatdisease categories or entities used to classify concrete cases ofdisease, are often defined by disease mechanisms or causalprocesses. Others suggest that diseases should always be definedin this manner. This paper discusses these standpoints criticallyand concludes that they are untenable, not only when `diseasemechanism' refers to an objective mechanism, but also when`mechanism' refers to a pragmatically demarcated part of thetotal ``objective'' causal structure of diseases. As an alternativeto principles that use the concept of disease mechanism (...) oranalogous concepts, a pragmatic approach is suggested anddescribed. This approach has been suggested before, but inproblematic or inadequate versions. This paper proposes a versioncompiled of two ``pragmatic principles'' and shows that they aremuch more adequate than the principle of disease mechanism. Withreference to a case study of a still ongoing internationaldiscussion of various candidates for a classification system formalignant lymphomas, including REAL (Revised European–AmericanClassification of Lymphoid Neoplasms) in which the concept ofdisease mechanism or analogous concepts plays a very small part,it is shown just how pivotal these two pragmatic principles canbe in actual discussions of definitions of diseases. Finally, itis pointed out that with regard to modern philosophy of languageit may, at least in some cases, be problematic to distinguishbetween the two pragmatic principles as they stand. (shrink)

I argue for accepting a pluralist approach to species, while rejecting the realism about species espoused by P. Kitcher and a number of other philosophers of biology. I develop an alternative view of species concepts as divisions of organisms into groups for study which are relative to the systematic explanatory interests of biologists at a particular time. I also show how this conception resolves a number of difficult puzzles which plague the application of particular species concepts.

Many philosophers and medical scientists assume that disease categories or entities used to classify concrete cases of disease are often defined by disease mechanisms or causal processes. Others suggest that diseases should always be defined in this manner. This paper discusses these standpoints critically and concludes that they are untenable, not only when 'disease mechanism' refers to an objective mechanism, but also when 'mechanism' refers to a pragmatically demarcated part of the total "objective" causal structure of diseases. As an alternative (...) to principles that use the concept of disease mechanism or analogous concepts, a pragmatic approach is suggested and described. (shrink)

The concept of disease has been the subject ofa vast, vivid and versatile debate. Categoriessuch as ``realist'', ``nominalist'', ``ontologist'',``physiologist'', ``normativist'' and``descriptivist'' have been applied to classifydisease concepts. These categories refer tounderlying theoretical frameworks of thedebate. The objective of this review is toanalyse these frameworks. It is argued that thecategories applied in the debate refer toprofound philosophical issues, and that thecomplexity of the debate reflects thecomplexity of the concept itself: disease is acomplex concept, and does not easily lenditself to definition.

The ways in which ethical issues arise in making clinical judgments are briefly discussed. By showing the topography of the role of value judgments in medical diagnostics it is suggested why clinical medicine remains inextricably a value-infected science.

The concept of disease has been the subject of a vast, vivid and versatile debate. Categories, such as "realist", "nominalist", "ontologist", "physiologist", "normativist" and "descriptivist", have been applied to classify disease concepts. These categories refer to underlying theoretical frameworks of the debate. The objective of this review is to analyze these frameworks. It is argued that the categories applied in the debate refer to profound philosophical issues, and that the complexity of the debate reflects the complexity of the concept itself: (...) disease is a complex concept, and does not easily lend itself to definition. (shrink)