Philosophy of Medicine

The philosophy of medicine is a subset of the philosophy of science that examines medical science and practice. Such reflection invites consideration of the nature of medicine—is it a rule-governed science or does the contingency of medical practice make it more of an art? Most would agree that medical science lacks the explanatory power of the physical sciences, but its grounding in robust bodies of life and health science research suggests something more systematic than praxis. As an alternative, medical science and medical practice can be regarded as distinct, as the goal of practice is to improve health while scientific study aims to achieve theoretical understanding. The insurgence of evidence-based methods to medical research over the past two decades, however, has challenged the framing of the goals of medical science. With its focus on outcomes research, clinical research has been largely redirected towards practical end of improving human health.  Philosophy of medicine is typically distinguished from biomedical ethics, although the distinction frequently blurs since it is often normative issues that motivate investigation into more theoretical questions. Fundamental questions addressed by philosophers of medicine tend to be epistemological and ontological by nature--analysis of meta-scientific concepts like reduction, models, theories, mechanisms, and causal inference and inquiry into the nature of health and disease. This humane orientation permitted a fruitful subset of late 20th century philosophy of medicine to diverge from the analytic orientation of Anglo-American philosophy of science to explore phenomenological investigation into the embodied experience of illness and dis-ease. The weighty human and social impact of medical science and practice also encouraged consideration of ethical and policy considerations in close tandem with the epistemic, ontological, and methodological debates that characterize the philosophy of medicine.

On the concepts of health and disease see Boorse 1977 's claim that they are descriptive concepts. This view is countered by Canguilhem 1989 normative account. On randomization in clinical trials,  see Papineau 1994 on the virtues of randomization versus Worrall 2007 and Vandenbrouke 2004. Evidence-based medicine, which champions randomized controlled trials as the gold standard, has been challenged by Feinstein & Horwitz 1997, Tonelli 1998, and Goldenberg 2006. On causal inference, see the classical debate between Hill 1965 and Fisher 1958, as well as McKay et al 2011. On Bayesian versus frequentist statistics in medicine, see Ashby 2006, Berry 1993, Whitehead 1993 On phenomenological investigations into the experience of illness and suffering, see Cassell 2004, Toombs 2001. On discovery and explanation, see Schaffner 1993 and Thagard 1999. On clinical judgment, see Feinstein 1967, Montgomery 2006.See Engel 1977 ’s influential biopsychosocial model of medicine.

Marcum 2010 Gifford 2011