Abstract

Recent discussion of the concept of disease has featured a line of argument centered on an alleged fact/value dichotomy. On this argument, the concept can be divided into a factual component comprised of facts described in scientific medical theories, and a normative component comprised of the evaluations that various cultures make of the disease experience. The facts of disease, the entities and events that medical science studies, are then held to be objective features of nature, whereas the values that different social milieus impose on the facts are held to be culture-bound and relative. I argue that the dichotomy is a false one based on a wrong-headed notion of science. That notion, articulated in the philosophy of scientific realism, holds that science aims to capture reality and that scientific facts are true just in case they correspond to objects in an observer-independent world. I argue for a different understanding of scientific activity: science aims to provide effective means of managing precarious human existence. At the most fundamental level, discrimination of the "facts" is guided by human interests; consequently, the strict division between facts and values cannot be maintained. However, some interests are more fundamental than others and, as regards the facts of disease, it is appropriate to seek a form of objectivity in the shared features of human need. Thus, I argue that, while the facts of scientific medicine cannot be held to correspond to reality, they can be observed to correspond to human medical interests in a way that is objective enough for practical purposes. I conclude by arguing for a pragmatic understanding of biomedical theories which holds that theories need not be taken as truthful in a realist sense, but are nonetheless useful in suggesting means to the control of disease phenomena