An historical survey of Thomas Kuhn's 1962 The Structure of Scientific Revolutions, charting the development of this influential work throughout Kuhn's career and exploring the continuing impact of Kuhn on the philosophy of science.

Medicine is facing several significant challenges as the twenty-first century unfolds, which represent barriers or limitations that threaten to cripple the advancement of medicine and its practice. One of the responses to these challenges is the emergence of systems medicine. And one of the more pertinent challenges is identifying and clarifying systems medicine's conceptual and theoretical foundations. The present book represents a sustained effort to examine this challenge and to map the terrain by which to engage it and to pursue (...) possible solutions. This conceptual and theoretical challenge in particular needs to be addressed to ensure the future success of systems medicine. To that end the book explores the conceptual and theoretical foundations of systems medicine, including the major concepts of organicism, emergence, and robustness, and contrasts these concepts to those for biomedicine, including mechanism, resultant, and homeostasis. Moreover, this challenge is critical because its resolution provides the intellectual scaffolding necessary for structuring the concepts and theories required to understand and explain more adequately or completely biological, physiological, and pathological mechanisms and processes. Importantly, with a robust conceptual and theoretical scaffolding, systems medicine must be implemented interdisciplinary not only within the medical community but also within the social and political communities, which the COVID-19 pandemic made so painfully obvious. (shrink)

Thomas S. Kuhn Thomas Samuel Kuhn, although trained as a physicist at Harvard University, became an historian and philosopher of science through the support of Harvard’s president, James Conant. In 1962, Kuhn’s renowned The Structure of Scientific Revolutions helped to inaugurate a revolution—the 1960s historiographic revolution—by providing a new image of science. For … Continue reading Kuhn, Thomas S. →.

In this book the author explores the shifting philosophical boundaries of modern medical knowledge and practice occasioned by the crisis of quality-of-care, especially in terms of the various humanistic adjustments to the biomedical model.

It is now—at least loosely—acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study—usually in a binary way—the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our (...) thinking from ‘cause and effect’ to ‘causes and effects’ since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a ‘causes and effects’ frame so we can choose the research methodology that reflects the relationships between variables of interest—one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand ‘causes and effects’. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple ‘causes and effects’ on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how ‘causes and effects’ explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity. (shrink)

A definitive and authoritative guide to a vibrant and growing discipline in current philosophy, The Bloomsbury Companion to Contemporary Philosophy of Medicine presents an overview of the issues facing contemporary philosophy of medicine, the research methods required to understand them and a trajectory for the discipline's future. -/- Written by world leaders in the discipline, this companion addresses the ontological, epistemic, and methodological challenges facing philosophers of medicine today, from the debate between evidence-based and person-centered medicine, medical humanism, and gender (...) medicine, to traditional issues such as disease, health, and clinical reasoning and decision-making. Practical and forward-looking, it also includes a detailed guide to research sources, a glossary of key terms, and an annotated bibliography, as well as an introductory survey of research methods and discussion of new research directions emerging in response to the rapid changes in modern medicine. -/- “Philosophy needs medicine', Hillel Braude argues, 'to become more relevant'. By showing how modern medicine provides philosophers with a rich source of material for investigating issues facing contemporary society, The Bloomsbury Companion to Contemporary Philosophy of Medicine introduces the opportunities medicine offers philosophers together with the resources and skills required to contribute to contemporary debates and discussions. (shrink)

Today, modern Western medicine is facing a quality-of-care crisis that is undermining the patient–physician relationship. In this paper, a notion of the epistemically virtuous clinician is proposed in terms of both the reliabilist and responsibilist versions of virtue epistemology, in order to help address this crisis. To that end, a clinical case study from the literature is first reconstructed. The reliabilist intellectual virtues, including the perceptual and conceptual virtues, are then discussed and applied to the case study. Next, a similar (...) method is employed to examine the responsibilist intellectual virtues, including curiosity, courage, honesty, and humility, and to apply them to the case study. To round out the discussion, the love of knowledge and both theoretical and practical wisdom are explored and applied to the case study. The paper concludes with a brief discussion of how the notion of an epistemically virtuous clinician addresses the quality-of-care crisis, in terms of the connection between ethical and intellectual virtues, and of the notion’s implications for medical education. (shrink)

The Covid-19 pandemic has challenged both medicine and governments as they have strived to confront the pandemic and its consequences. One major challenge is that evidence-based medicine has struggled to provide timely and necessary evidence to guide medical practice and public policy formulation. We propose an extension of evidence-based corona medicine to an organismic systems corona medicine as a multilevel conceptual framework to develop a robust concept-oriented medical system. The proposed organismic systems corona medicine could help to prevent or mitigate (...) future pandemics by transitioning to a bifocal medicine that extends an empirical evidence-based medicine to a theory-oriented organismic systems medicine. (shrink)

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. According (...) to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

Metaphysical presuppositions are important for guiding scientific practices and research. The success of twentieth-century biology, for instance, is largely attributable to presupposing that complex biological processes are reducible to elementary components. However, some biologists have challenged the sufficiency of reductionism for investigating complex biological phenomena and have proposed alternative presuppositions like organicism. In this article, contemporary cancer research is used as a case study to explore the importance of metaphysical presuppositions for guiding research. The predominant paradigm directing cancer research is (...) the somatic mutation theory, in which mutated genes are presumed to be ultimately responsible for explaining carcinogenesis. This reductionistic approach to cancer has been criticised recently, and an organistic approach has been proposed. The article concludes with a discussion of the reciprocal interaction of metaphysical presuppositions and scientific practices for investigating cancer's complex nature. (shrink)

A notion of experimental series is developed, in which experiments or experimental sets are connected through experimental suggestions arising from previous experimental outcomes. To that end, the justification of Howard Temin’s DNA provirus hypothesis is examined. The hypothesis originated with evidence from two exploratory experimental sets on an oncogenic virus and was substantiated by including evidence from three additional experimental sets. Collectively these sets comprise an experimental series and the accumulative evidence from the series was adequate to justify the hypothesis (...) by persuading the virology community of its veracity. The notion of crucial experiment is also discussed in terms of experimental series. (shrink)

A notion of experimental series is developed, in which experiments or experimental sets are connected through experimental suggestions arising from previous experimental outcomes. To that end, the justification of Howard Temin's DNA provirus hypothesis is examined. The hypothesis originated with evidence from two exploratory experimental sets on an oncogenic virus and was substantiated by including evidence from three additional experimental sets. Collectively these sets comprise an experimental series and the accumulative evidence from the series was adequate to justify the hypothesis (...) by persuading the virology community of its veracity. The notion of crucial experiment is also discussed in terms of experimental series. (shrink)

What is medical progress? The answer to this question is often associated with advances in diagnostic technology, with greater understanding of disease or pathological mechanisms particularly at the molecular level, or with the discovery of drugs and the developmental of surgical procedures to treat diseases. However, this facile answer can be problematic. In a New York Times Magazine article, for example, Lisa Sanders (2003) recounts a lecture delivered to her first-year class, at a "white-coat" ceremony, by the medical school dean. (...) Half of what we—the faculty—teach you—the students—is nonsense, she was told, but we don't know which half. She illustrates what the dean said, with the following change in advice for .. (shrink)

For at least the past several decades, medicine has been embroiled in a crisis concerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professionalism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-à-vis these questions is examined and analyzed chiefly in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their (...) writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolving health care network must also be considered. To that end, I first discuss the genesis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensified during the twentieth century, particularly in terms of medicine’s ultimate scientification and eventual commercialization, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for addressing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defining itself in terms of the professionalism for each of the other professions within the health care network. (shrink)

In the seventeenth century, Newton published his famous experimentum crucis, in which he claimed that light is heterogeneous and is composed of rays with different refrangibilities. Experiments, especially the crucial experiment, were important for justifying Newton’s theory of light, and eventually his theory of color. A century later, Goethe conducted a series of experiments on the nature of color, especially in contradistinction to Newton, and he defended his research with a methodological principle formulated in “Der Versuch als Vermittler.” Goethe’s principle (...) included two elements: a series of experiments and resultant higher empirical evidence, which functioned as mediator between the objective and the subjective . Although the notion of experimentum crucis became popular among scientists for reconstructing experimental research and for justifying theories, especially for rhetorical purposes, Newton’s justification of his theory of light and color is best reconstructed in terms of Goethe’s methodological principle. Finally, Goethe’s principle has important consequences for the contemporary philosophical underdetermination thesis. (shrink)

Is knowledge in the natural sciences discovered or constructed? For objectivists, scientific knowledge is discovered through investigations into a mind-independent, natural world. For constructivists, such knowledge is produced through negotiations among members of a professional guild. I examine the clash between the two positions and propose that scientific knowledge is the concurrent outcome from investigations into a natural world and from consensus reached through negotiations of a professional guild. Specifically, I introduce the general methodological notion, instituting science, which incorporates both (...) the discovery and the construction processes in the generation of scientific knowledge. To that end, I use a case study from the biomedical sciences to illustrate the notion. I conclude with a discussion of how this methodological notion helps to address the debate between objectivists and constructivists over the generation of scientific knowledge, and of how it compares with others who have also attempted to address the debate. (shrink)

Robust clinical decision-making depends on valid reasoning and sound judgment and is essential for delivering quality healthcare. It is often susceptible, however, to a clinician’s biases such as towards a patient’s age, gender, race, or socioeconomic status. Gender bias in particular has a deleterious impact, which frequently results in cognitive myopia so that a clinician is unable to make an accurate diagnosis because of a patient’s gender—especially for female patients. Virtue epistemology provides a means for confronting gender bias in clinical (...) decision-making and for correcting or even preventing its impact. The medical literature on cardiovascular and coronary heart disease is used to illustrate the role intellectual virtues can play in redressing the deleterious impact of gender bias on clinical decision-making and practice. Finally, questions are considered surrounding the pedagogy of intellectual virtues for medical students and practicing clinicians in order to provide quality care for patients, regardless of gender. (shrink)

During the twentieth century, a controversy raged over the role of electrical forces and chemical substances in synaptic transmission. Although the story of the ‘main’ participants is well documented, the story of ‘lesser’ known participants is seldom told. For example, Alexander Forbes, who was a prominent member of the axonologists, played an active role in the controversy and yet is seldom mentioned in standard accounts of the controversy. During the 1930s, Forbes incorporated chemical substances into his theory of synaptic transmission, (...) advocating a complementarity model for the role of electrical forces and chemical substances. By focusing on Forbes and the axonologists, the controversy is simply more than a debate over ‘soup’ vs. ‘sparks’ but also involves the relative roles of electrical forces and chemical substances in synaptic transmission. The implications of this case study for the nature of scientific controversies are also discussed. (shrink)

Scientists generally record their laboratory activities and experimental results in notebooks, from which they construct scientific papers. The Johns Hopkins physiologist William Henry Howell kept a laboratory notebook from 1913 to 1914, in which he recorded experiments on the blood clotting factor prothrombin. In 1914 he published a paper using this notebook, to justify his theory of prothrombin activation. Howell's paper is reconstructed, in terms of its narrative and argument elements, from the laboratory activities and experimental results recorded in the (...) notebook. This reconstruction reveals an intimate connection between the two texts and the process by which Howell constructed a scientific paper. The generation of scientific knowledge by Howell is then evaluated, especially in terms of theory formation and justification. (shrink)

Biology as a scientific discipline has relied heavily upon advances in chemistry and physics. An inherent danger in this relationship is the reduction of living phenomena to physico-chemical terms. Whitehead's Philosophy of Organism is utilized to examine current methodologies within biology and to evaluate their appropriateness for future research. Hemostatic regulation is employed to illustrate the applications of organistic concepts to biological research. It is concluded that understanding of living entities and their properties as well as possibly life itself will (...) require synthesis of the many analytical elements as informational structures. (shrink)

Both religion and science provide powerful images of human origins and human nature. Often these images are seen as incompatible or irreconcilable, with the religious image generally marginalized vis-à-vis the scientific image. Recent genetic studies into human origins, especially in terms of common cellular features like the mitochondrion from females and the Y-chromosome from males, provide evidence for common ancestors called mitochondrial Eve and Y-chromosomal Adam. The aim of this paper is to expound upon the Judeo-Christian and western scientific images (...) of humanity with respect to human origins and human nature, especially in terms of possible reconciliation of the two images. (shrink)

An important question facing contemporary philosophy of science is whether the natural sciences in terms of their historical records exhibit distinguishing developmental patterns or structures. At least two philosophical stances are possible in answering this question. The first pertains to the plurality of the individual sciences. From this stance, the various sciences are analyzed individually and compared with one another in order to derive potential commonalities, if any, among them. The second stance involves a general philosophy of science in which (...) a thorough theory of the natural sciences is developed. The latter stance strives to account for more than possible commonalities among the sciences but also to provide a broad-spectrum philosophical framework to account for, or to explicate, the nature of science itself and its progress. In this paper, the second stance is taken in which an evolutionary philosophy of science is proposed. To that end, Thomas Kuhn’s evolutionary philosophy of science is initially discussed and critiqued. An evolutionary philosophy of science is then proposed based on a revision of Kuhn’s evolutionary philosophy of science in terms of George Gaylord Simpson’s various tempos and modes for biological evolution. Next, two historical case studies from the biological sciences are reconstructed to illustrate the robustness of the proposed evolutionary philosophy of science for explicating the progress of the natural sciences. A concluding section discusses the proposed evolutionary philosophy of science with respect to providing a broad-spectrum framework or general philosophy of science for understanding the nature and progress of the natural sciences. (shrink)

The book starts with a scandal, that is, Socrates’s mortality as entailed in the Aristotelian syllogism,All men are mortal,Socrates is a man,Therefore, Socrates is mortal. The scandal pertains to the deduction of Socrates’s death from the logical connections of premises, which, according to Braude, renders it “meaningless.” But, what does this scandal have to do with a philosophical defense of intuition in medicine? For Braude, the scandal is emblematic of a crisis in medicine and philosophy—a crisis in which human mortality (...) is severed from its morality. Braude articulates the crisis with the following question:Where, therefore, between the cracks of universal logic and reifying medicine is there a place for the individual patient, for a response to the cry of pain to which medicine responds, or to the voice of injustice upon which moral philosophy is founded? For him, intuition provides a means to answer the question and thereby to resolve the crisis. It serves as “a bridge be .. (shrink)

Proponents of the dual-process theory claim that two distinct types of mental faculties or minds are responsible for human cognition. The first is evolutionarily old and not unique to humans but shared with other organisms. Type-1’s key feature is autonomy from cognitive capacities; hence, it does not require working memory. Type-2 is evolutionarily recent and thought to be uniquely human. Its key feature is reflective cognitive-decoupling of Type-1 processes, if warranted; and it requires working memory. Critics, however, argue that one (...) mind is sufficient to account for human cognition and propose a unimodel theory of cognition. The debate over these theories depends upon metaphysical notions concerning the nature of cognitive capacities and processes; and, how to investigate and explain them. In this paper, I explore these notions in terms of analyzing the metaphysical presuppositions of dualism and monism, and then the methodological approaches of holism and reductionism, as well as the ontological categories of organicism and physicalism, which are often unspecified and/or unexamined in the cognition debate. Clarification of these metaphysical notions and consideration of others is important for progressing towards the debate’s resolution. To that end, a plurimodel theory of cognition—based on a metaphysical presupposition and a methodological approach of pluralism and pragmatism, respectively, as well as on an ontological category of dynamical system—is introduced and discussed. (shrink)

Approaches to the analysis of theory choice in science studies often focus either on objective criteria or subjective values for evaluating theories or on critical experiments for testing theories. In the present article a historical case study in the biomedical sciences is reconstructed, in which experimentation was performed to choose between two competing theories of blood coagulation. Analysis of this case study reveals that experimentation exhibits a particular structure, composed of design, execution, and results, and specific characteristics, consisting of controllability, (...) reproducibility, plasticity, and fecundity. Although this structure and these characteristics are not used to replace objective criteria or subjective values of theory evaluation or to define critical experiments, they are instrumental for analyzing and understanding theory choice. (shrink)

In this article, I introduce the notion of horizon for scientific practice (HSP), representing limits or boundaries within which scientists ply their trade, to facilitate analysis of scientific discovery and progress. The notion includes not only constraints that delimit scientific practice, e.g. of bringing experimentation to a temporary conclusion, but also possibilities that open up scientific practice to additional scientific discovery and to further scientific progress. Importantly, it represents scientific practice as a dynamic and developmental integration of activities to investigate (...) and analyze the natural world. I use the discovery of the clotting factor, thrombin, and the experiments conducted by the Johns Hopkins physiologist, William Howell, on the enzymatic nature of thrombin to illustrate the notion of HSP. In a concluding section, I compare the notion of HSP to other notions for scientific practice proposed in the history and philosophy of science literature. (shrink)

In The Structure of Scientific Revolutions, Kuhn claimed that theory choice is a conversion experience and depends upon the personality or psychology of the individual scientist making the choice. Critics charged Kuhn with an irrational and a relativistic position concerning theory choice, arguing he advocated a subjective instead of an objective approach to how scientists choose one theory over another and thereby undercut epistemic accounts for the generation of scientific knowledge. In response to critics Kuhn insisted that his approach, although (...) subjective, was still rational in that the criteria—composed of epistemic values—determining theory choice operate both objectively and subjectively. Recent work in cognitive neuropsychology, particularly in the dual-process theory of cognition, supports Kuhn’s notion of theory choice. In this paper, I initially discuss Kuhn’s approach to theory choice, along with criticism of it and his response to the criticism, followed by an examination of the dual-process theory of cognition. I then explore the application of dual-process theory to Kuhn’s notion of theory choice, especially in terms of a historical case study from the biomedical sciences. I finally discuss briefly the implications of the dual-process theory for contemporary philosophy of science. (shrink)

This essay examines the metaphysical foundations of the natural sciences and Christian theology in order to complement the epistemic claims from both disciplines. These foundations include Robin Collingwood's notion of presuppositions and Ernan McMullin's epistemic and non-epistemic values. Specifically, the essay investigates the presuppositions and values of science and theology used for guiding and constraining the formation and evaluation of scientific theories and theological doctrines. Practitioners in both disciplines need to keep these presuppositions and values in mind when complementing epistemic (...) claims to form a comprehensive world picture. Complementing scientific and theological claims requires wisdom and restraint in analyzing the presuppositions and values that make such claims possible. For, theology without the input of science, and science without the input of theology, may lead to an impoverished world picture. (shrink)

At times scientists manipulate their community's perception of scientific discoveries. The following case study illustrates the extent to which a community's understanding of a discovery was influenced by one of its members. In the 1870s the British physiologist Arthur Gamgee undertook a campaign to insure Andrew Buchanan of Glasgow credit for his blood clotting research, conducted from the early 1830s to the mid-1840s. Gamgee endeavored to establish Buchanan as the discoverer of fibrin ferment, a clotting factor first isolated and named (...) in 1872 by Alexander Schmidt of Dorpat. Gamgee's campaign included the solicitation of support for Buchanan from contemporary physiologists, by discussing Buchanan's work in his publications and by demonstrating through experimentation that the material extracted from Buchanan's washed blood clots was similar, if not identical, to Schmidt's fibrin ferment. Gamgee's influence on the scientific community's perception of the discovery was effective, and Buchanan is generally considered the discoverer of the clotting factor and Schmidt its rediscoverer. However, examination of Buchanan's research in blood coagulation and the context in which he conducted the research reveals that Buchanan is neither the discoverer of fibrin ferment nor even a precursor to Schmidt. (shrink)