Philosophy of Medicine

Perspectives on Evidence-Based Healthcare for Women

by Maya Goldenberg

The Historical Foundations of the Research-Practice Distinction

by Yashar Saghai

Co-authored with Tom Beauchamp

Theoretical Medicine and Bioethics, 33 (1): 45–56, 2012
DOI 10.1007/s11017-011-9207-8

The distinction between clinical research and clinical practice directs how we partition medicine and biomedical... more The distinction between clinical research and clinical practice directs how we partition medicine and biomedical science. Reasons for a sharp distinction date historically to the work of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, especially to its analysis of the “boundaries” between research and practice in the Belmont Report (1978). Belmont presents a segregation model of the research-practice distinction, according to which research and practice form conceptually exclusive sets of activities and interventions. This model is still the standard in federal regulations today. However, the Commission’s deliberations and conclusions about the boundaries are more complicated, nuanced, and instructive than has generally been appreciated. The National Commission did not conclude that practice needs no oversight comparable to the regulation of research. It debated the matter and inclined to the view that the oversight of practice needed to be upgraded, though the Commission stopped short of proposing new regulations for its oversight, largely for prudential political reasons.

Mechanistic evidence: Disambiguating the Russo-Williamson Thesis

by Phyllis Illari

International Studies in the Philosophy of Science. 25(2), (2011): 139–57.
DOI:10.1080/02698595.2011.574856

Russo and Williamson claim that establishing causal claims requires mechanistic and difference-making evidence. In this... more Russo and Williamson claim that establishing causal claims requires mechanistic and difference-making evidence. In this paper, I will argue that Russo and Williamson’s formulation of their thesis is multiply ambiguous. I will make three distinctions: mechanistic evidence as type vs object of evidence; what mechanism or mechanisms we want evidence of; and how much evidence of a mechanism we require. I will feed these more precise meanings back into the Russo-Williamson Thesis and argue that it is both true and false: two weaker versions of the thesis are worth supporting, while the stronger versions are not. Further, my distinctions are of wider concern because they allow us to make more precise claims about what kinds of evidence are required in particular cases.

Ancient Greek Medicine as the Foundation of Contemporary Medicine

by Vasiliki Kanellou

Kanellou, V. 2004. 'Techniques in Coloproctology', Volume 8, Supplement 1, pages 3-4

Can Illness Be Edifying?

by Ian James Kidd

Forthcoming in Inquiry.

Havi Carel has recently argued that one can be ill and happy. An ill person can ‘positively respond’ to illness by... more Havi Carel has recently argued that one can be ill and happy. An ill person can ‘positively respond’ to illness by cultivating ‘adaptability’ and ‘creativity’. I propose that Carel’s claim can be augmented by connecting it with virtue ethics. The positive responses which Carel describes are best understood as the cultivation of virtues and this adds a significant moral aspect to coping with illness. I then defend this claim against two sets of objections and conclude that interpreting Carel’s phenomenology of illness within a virtue ethical framework enriches our understanding of how illness can be edifying.

« La transparence du corps en médecine : obscur modèle de notre modernité »

by Klein Alexandre

Alloa, E., Guindani, S., « La transparence : esthétique et politique », Appareil, n°7, 2011

The Return of Vitalism: Canguilhem and French Biophilosophy in the 1960s

by Charles Wolfe

2009 version

The eminent French biologist and historian of biology, François Jacob, once notoriously declared “On n’interroge plus... more The eminent French biologist and historian of biology, François Jacob, once notoriously declared “On n’interroge plus la vie dans les laboratoires”: laboratory research no longer inquires into the notion of ‘Life’. Nowadays, as David Hull puts it, “both scientists and philosophers take ontological reduction for granted… Organisms are ‘nothing but’ atoms, and that is that.” In the mid-twentieth century, from the immediate post-war period to the late 1960s, French philosophers of science such as Georges Canguilhem, Raymond Ruyer and Gilbert Simondon returned to Jacob’s statement with an odd kind of pathos: they were determined to reverse course. Not by imposing a different kind of research program in laboratories, but by an unusual combination of historical and philosophical inquiry into the foundations of the life sciences (particularly medicine, physiology and the cluster of activities that were termed ‘biology’ in the early 1800s). Even in as straightforwardly scholarly a work as La formation du concept de réflexe aux XVIIe et XVIIIe siècles (1955), Canguilhem speaks oddly of “defending vitalist biology,” and declares that Life cannot be grasped by logic (or at least, “la vie déconcerte la logique”). Was all this historical and philosophical work merely a reassertion of ‘mysterian’, magical vitalism? In order to answer this question we need to achieve some perspective on Canguilhem’s ‘vitalism’, notably with respect to its philosophical influences such as Kurt Goldstein.

‘Kant, Buddhism, and the Moral Metaphysics of Medicine’

by Stephen Palmquist

Journal of Indian Philosophy and Religion 7 (October 2002), pp.79-97 (co-authored with Adriano Palomo)

This paper examines Kant's moral theory and compares it with certain key aspects of oriental (especially Buddhist)... more This paper examines Kant's moral theory and compares it with certain key aspects of oriental (especially Buddhist) moral philosophy. In both cases, we focus on the suggestion that there may be a connection between a person's physical health and moral state. Special attention is paid to the nature of pain, illness, and personal happiness and to their mutual interrelationships.
A frequently ignored feature of Kant's approach to morality is his preoccupation with health, and his attempt to interpret it in terms of the moral law. An obvious antithesis of the health-moral imperative would be an illness-pathological imperative; we will regard both as forms imposed on our experience by the human mind. We demonstrate that the Kantian path to understanding the “moral metaphysics of medicine” can be supported by Tibetan medicine and Buddhist ethics.
What Buddhism understands as moral law, or “Sila”, corresponds directly to Kant's theory. In both cases, health is the supreme judge that demonstrates whether or not our moral state is justifiable. Our principal intention is to show that, through the power of mind, a person’s moral state can--and in fact does--influence the body, having as its expression either health or illness. By considering the relevance of the Kantian interpretation of morality to medicine, we regard proper attention to the former as the surest path to the goal of maintaining personal health.

A Problem for Achieving Informed Choice

by Adam La Caze

To Cure Sometimes, To Comfort Always, To Hurt The Least, To Harm Never

by Ajai Singh

Mens Sana Monographs 2006 Editorial

Medicine has to engage in battle on numerous fronts. To further scientific enquiry without giving up on the art of... more Medicine has to engage in battle on numerous fronts. To further scientific enquiry without giving up on the art of caring. To find more efficient methods of care, ameliorate disease and attendant suffering, without overriding human rights. To experiment, carry out clinical trials and refine processes of experimentation, without allowing human beings, especially from underprivileged sections, to be coerced, subtly or otherwise, and/or recruited without informed consent. To continue to further patient welfare without snubbing the corporate enterprise of medicine. To further this enterprise, as it holds great promise for scientific advancement, without encouraging its equally great potential for malevolence...

Evidence-Based Medicine Must Be...

by Adam La Caze

Modern Medicine: Towards Prevention, Cure, Well-being and Longevity

by Ajai Singh

Mens Sana Monographs 2010

Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields,... more Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, deserve attention; as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely.

'Placebos' and the logic of placebo comparison

by Andrew Turner

Turner, A (2012) 'Placebos' and the logic of placebo comparison, Biology and Philosophy, 27(3), 419-432 Turner, A (2012) 'Placebos' and the logic of placebo comparison, Biology and Philosophy, 27(3), 419-432

Introduzione alla medicina avestica

by Paolo Delaini

Conoscenze mediche sul corpo come tramite di cultura tra Oriente e Occidente, Milano, Mimesis 2010.

Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research

by Christian Munthe

co-authored with Lars Sandman and Daniela Cutas. Published in Health Care Analysis, 2011, vol. 19, DOI: 10.1007/s10728-011-0183-y

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different... more This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

Retrieving Kamala: from the debris of epistemic violence

by Anup Dhar

From the Margins: a journal of critical theory, 1998.

This paper is auto-bio-graphical.

It sets up a deconstructive relation with Western Medicine. This paper is auto-bio-graphical.

It sets up a deconstructive relation with Western Medicine.

A Pluralist Challenge to ‘Integrative Medicine’: Feyerabend and Popper on the Cognitive Value of Alternative Medicine.

by Ian James Kidd

Studies in History and Philosophy of Biological and Biomedical Sciences, forthcoming.

This paper is a critique of ‘integrative medicine’ as an ideal of medical progress on the grounds that it fails to... more This paper is a critique of ‘integrative medicine’ as an ideal of medical progress on the grounds that it fails to realise the cognitive value of alternative medicine. After a brief account of the cognitive value of alternative medicine, I outline the form of ‘integrative medicine’ defended by the late Stephen Straus, former director of the US National Centre for Complementary and Alternative Medicine. Straus’ account is then considered in the light of Zuzana Parusnikova’s recent criticism of ‘integrative medicine’ and her distinction between ‘cognitive’ and ‘opportunistic’ engagement with alternative medicine. Parusnikova warns that the medical establishment is guilty of ‘dogmatism’ and proposes that one can usefully invoke Karl Popper’s ‘critical rationalism’ as an antidote. Using the example of Straus, I argue that an appeal to Popper is insufficient, on the grounds that ‘integrative medicine’ can class as a form of cognitively-productive, critical engagement. I suggest that Parusnikova’s appeal to Popper should be augmented with Paul Feyerabend’s emphasis upon the role of ‘radical alternatives’ in maximising criticism. ‘Integrative medicine’ fails to maximise criticism because it ‘translates’ alternative medicine into the theories and terminology of allopathic medicine and so erodes its capacity to provide cognitively-valuable ‘radical alternatives’. I conclude that ‘integrative medicine’ fails to exploit the cognitive value of alternative medicine and so should be rejected as an ideal of medical progress.

Corpul şi persoana

by Cecilia Tohaneanu

Interpretare le lastre

by Francesco Galofaro

Originariamente pubblicato in Il discorso della salute, a cura di Gianfranco Marrone, Meltemi, Roma, 2005

il mio intento è mostrare la struttura di un metalinguaggio scientifico funzionale all’interpretazione dei radiogrammi... more il mio intento è mostrare la struttura di un metalinguaggio scientifico funzionale all’interpretazione dei radiogrammi da parte del medico. Un metalinguaggio non può essere genericamente identificato con gerarchie concettuali ad albero (iponimo/iperonimo), come fa Eco (1984). La struttura di un metalinguaggio comprende un doppio albero di categorie per il piano dell’espressione e del contenuto, ed è cruciale la relazione che si instaura tra loro. Occorrerebbe prendere in considerazione dunque il funzionamento di metalinguaggi scientifici, indispensabili da un punto di vista epistemologico, prima di procedere a frettolose condanne. Quel che scrivo in questo saggio andrebbe letto insieme a "Dal reperto al referto. Traduzione intersemiotica nella diagnostica per immagini", dove mi sono occupato del tema del mutamento in un linguaggio scientifico - Galofaro (2006).

Time and the consultation – an argument for a 'certain slowness'

by Joachim Sturmberg

JP Sturmberg and P Cilliers, published in Journal of Evaluation in Clinical Practice 2009

When natural time sequences were replaced by clocks, time became a measurable commodity and the 'speedy use of time' a... more When natural time sequences were replaced by clocks, time became a measurable commodity and the 'speedy use of time' a virtue. In medical practice shorter consultations allow more patients to be seen, whereas longer consultations result in a better understanding of the patient and her problems. Crossing the line of time-efficiency and time-effectiveness compromises the balance between short-term turnover and long-term outcomes. The consultation has all the hallmarks of a complex adaptive system whose characteristics are not determined by the characteristics of the components, but by the patterns of interaction among the components. Systems are dynamic and change over time; the dynamic nature is not incidental, but necessary as complex systems operate at conditions far from equilibrium. The central notion when we talk of time and complexity is that of 'memory'. Memory is carrying something from the past over into the future. Memory is filtered/interpreted, separating noise from information. Memory therefore is not an instantaneous thing, it takes time to develop; it is slow. The dynamics between the participating agents in the consultation will create shared memories that live on to shape future interactions. Shared memories are stronger and contain more relevant knowledge if they are based on frequent interactions and ongoing doctor–patient relationships, leading to a better understanding of the whole person – a process that takes time. Sufficient time, that is, 'a certain slowness', is an essential element of the healing relationship in the consultation. It creates a sufficiently stable, but adaptive, environment that can withstand changing demands. Hence a more complete understanding of the consultation and its time demands will not only lead to more effective treatment, it will also humanize a situation which has become to a large extent purely instrumental. This process of humanization is important not only for the patient, but also for the doctor.