How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology.While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In (...) addition, the broader purview offered by social epistemology opens up opportunities to address new topics such as the role of consensus conferences, epistemic injustice, the value of medical knowledge, continuing medical education, and industry funding. This article situates and summarizes the contributions to this special issue. (shrink)

This essay examines the interrelationship between legal, medical, and public knowledge in the case of Mary Mallon. The author argues that although Mallon was never convicted of any crime, she was under the constant surveillance of medical authorities because of her characterization as a recalcitrant typhoid carrier. Mallon's physical body became a contested site of controversy as various medical and legal communities fought for the legitimization of their own bodies of knowledge. Modern health care theorists (...) and practitioners still use a plethora of Typhoid Mary narratives in their discussions of the relationship between jurisprudence, ethics, and medicine. (shrink)

A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been (...) suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public’s best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach. (shrink)

Robin Downie has distinguished between two enduring cognitive and practical attitudes that have determined the way that doctors and societies thought about medicine. The Hippocratic tradition attached its faith to empirical observation and rational induction and deduction, while the Asklepian approach was holistic, intuitive and strongly spiritual. Hippocrates sought to generalize from individual observations, to generate rules and guidelines from pooled experience. Asklepian physicians believed that cure lay in understanding the personal experience of each patient, and in providing an ambience (...) of healing centered on temples and sacred ground. Hippocratic medicine emphasized the empirical.. (shrink)

Because few would object to evidence-based medicine’s (EBM) principal task of basing medical decisionmaking on the most judicious and up-to-date evidence, the debate over this prolific movement may seem puzzling. Who, one may ask, could be against evidence (Carr-Hill, 2006)? Yet this question belies the sophistication of the evidence-based movement. This chapter presents the evidence-based approach as a socio-medical phenomenon and seeks to explain and negotiate the points of disagreement between supporters and detractors. This is done by casting (...) EBM as more than the simple application of research findings to clinical care and improved health outcomes, but rather an umbrella term that harnesses a specific set of pedagogical objectives (some rather radical) under a name that makes it difficult to argue against. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of (...) this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

In all European countries, the eighteenth century was characterised by efforts to improve the vernaculars. The Transylvanian case study shows how both codified medical language and ordinary language were constructed and enriched by a large number of medical books and brochures. The publication of medical literature in Central European vernacular languages in order to popularise new medical knowledge was a comprehensive programme, designed on the one hand by intellectual, political and religious elites who urged the (...) improvement of the fatherland and the promotion of the common good by perfecting the arts and sciences. On the other hand, the imperial administration’s initiatives affected local forms of medical knowledge and the construction of vernacular languages. In the eighteenth century, the construction of vernacular languages in the Habsburg Monarchy took on a significant political character. However, in the process of building of the scientific and medical vocabulary, the main preoccupation was precision, clarity and accessibility of the neologisms being invented to encompass the medical phenomena being described. In spite of political conflicts among the ‘nations’ living in Transylvania, physicians borrowed words from German, Hungarian and Romanian. Thus they elevated several words used in everyday language to the upper social stratum of language use, leading to the invention of new terms to describe particular medical practices or phenomena. (shrink)

Applying general and statistical knowledge to individuals is difficult either on epidemiological or epistemological grounds. This paper examines these difficulties from the perspective of computer registers of epidemiological data.

In 1995 the People's Republic of China passed a controversial Eugenics Law, which, after a torrent of international criticism, was euphemistically renamed the Maternal and Infant Health Law. Aimed at "the implementation of premarital medical checkups" to ensure that neither partner has any hereditary, venereal, reproductive, or mental disorders, the ordinance implies that those deemed "unsuitable for reproduction" should undergo sterilization or abortion or remain celibate in order to prevent "inferior births." Using this recent statute as a springboard, Frank (...) Dikötter explores the contexts and history of eugenics in both Communist China and Taiwan. Dikötter shows how beginning in Late Imperial China, Western eugenics was imported and combined with existing fears of cultural, racial, or biological degeneration in Chinese society, leading to government regulation of sexual reproduction. _Imperfect Conceptions_ is a revealing look at the cultural history of medical explanations of birth defects that demonstrates how Chinese assumptions about the relationship of the individual to society form the very core of their attitudes toward procreation. Dikötter explains the patrilineal model of descent, where a person is viewed as the culmination of his or her ancestors and is held responsible for the health of all future generations. By this logic, a pregnant woman's behavior and attitude directly influence the well-being of her baby, and a deformed or retarded child reflects a moral failing on the part of the parents. Dikötter also shows how the holistic medicine practiced in China blurs any distinction between individual and environment so that people are held responsible for illness. Drawing on cultural, social, economic, and political approaches, Dikötter goes beyond a simple authoritarian model to provide a more complex view of eugenic policy, showing how a variety of voices including those of popular journalists, social reformers, medical writers, sex educators, university professors, and politicians all disseminate information that supports rather than questions the state's program. _Imperfect Conceptions_ reveals how Chinese cultural currents--fear and fascination with the deviant and the urge to draw clear boundaries between the normal and the abnormal--have combined with medical discourse to form a program of eugenics that is viewed with alarm by the rest of the world. (shrink)

What follows is a brief comment on Ludwik Fleck's paper on the foundations of medical knowledge translated by Thaddeus J. Trenn in this issue. Since the original is much older than I am, I have some scruples in presenting the critical thoughts which occurred to me when I read it a few years ago. Despite the criticism, I am very sympathetic to most of what Fleck has told us in his tragically neglected work. Two facts make Fleck's tragedy (...) even more disturbing: (i) others have given rise to post-Fleck revolutions in epistemology by exploiting his ideas while omitting proper references to him, and (ii) sociology of science, precisely what Fleck wanted to promote, has emerged without his work being operative in any sense. In my commentary, I shall examine his concept of social conditioning of knowledge. CiteULike Connotea Del.icio.us What's this? (shrink)

Las redes sociales asociadas al conocimiento resultan de interés tanto a los estudios en Ciencia Tecnología y Sociedad, como al desenvolvimiento del pensamiento de la complejidad que se desarrolla en el país. Su análisis explica la naturaleza social de la producción científica y la existencia del capital social, cuyas características se vinculan con la satisfacción y resolución de las necesidades sociales dentro de la población cubana. Se muestra una red, conformada en torno a la Publicación Archivo Médico de Camagüey, durante (...) los años 2003, 2004 y dos bimestres del 2005 sobre el desenvolvimiento de las co autorías dentro de ella. Delineando en qué forma los investigadores se relacionaron entre sí, para valorar algunos de sus resultados. Se describen, los grupos esenciales de investigación y sus principales fortalezas. Constituye una herramienta de trabajo, al exponer los cambios que están ocurriendo en torno a la Universidad Médica Camagüeyana The social networks associated to human knowledge are useful to the studies in Science Technology and Society. Their analysis explains the social nature of the scientific production and the existence of social resources, which link the satisfaction and resolution of the social necessities inside the Cuban population. The characteristics of this networks conformed in Archivo Médico de Camagüey publication on the development of co authorship from 2003 to 2005 were presented in this article. The researchers were related to each other in this work to value in which way they function together and analyze some of their results. The essential groups of investigation and their main strengths were also described. It constitutes a work tool for further research works, to considering the changes that are happening about the scientific knowledge production in Camagüey University of Medicine. (shrink)

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this (...) class='Hi'>knowledge relates to the ‘world out there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

There has been a modern epidemic of heart attacks in the western world, and this paper is concerned with this ‘new’ medical condition and how it arose. Two competing theories are commonly proposed, relating either to conventional accounts of medical science, or to social construction. Whilst recognising that aspects of both theories have some validity, it is claimed that neither is wholly adequate. This issue has particular relevance for heart attacks and is explored in some detail, but it (...) also points to some more general conclusions. First that medical knowledge cannot be separated into ‘scientific’ and ‘social’ compartments but is united by its human aspect; and second that although medical knowledge has a special dimension, when understood in this way, it may also resonate with a more general re-examination of the relationship between scientific and human knowledge. (shrink)

This study examines how low-income African American mothers of children with sickle cell disease cope with the reproductive implications of having passed a genetic disease on to their children. Based on in-depth interviews with 29 African American mothers, I found that most mothers knew about SCD prior to having a child with the disease; many knew they were carriers of the sickle cell trait. In explaining why this knowledge did not lead them to alter their reproductive behaviors, mothers invoked (...) a theme of medical mismanagement; that is, they said the genetic screening programs for SCD did not provide them with enough medical knowledge about the disease. The implication that adequate knowledge about SCD would have affected their childbearing choices, however, is contradicted by their subsequent reproductive behaviors. I argue that the SCD diagnosis threatened motherhood, an important cultural value among low-income African American women, and that they protected their reproductive autonomy by obfuscating SCD medical knowledge. (shrink)

The pharmaceutical industry, in its marketing efforts, often turns to “key opinion leaders” or “KOLs” to disseminate scientific information. Drawing on the author's fieldwork, this article documents and examines the use of KOLs in pharmaceutical companies’ marketing efforts. Partly due to the use of KOLs, a small number of companies with well-defined and narrow interests have inordinate influence over how medical knowledge is produced, circulated, and consumed. The issue here, as in many other cases of institutional corruption, is (...) that a few actors have accumulated the power to shape the information on which many others base their decisions. Efforts to address this corruption should focus on correcting large imbalances in the current political economy of medical knowledge. A sequestration of pharmaceutical research and development on one hand from pharmaceutical marketing on the other, though difficult to achieve, would address this and many other problems. (shrink)

The following text is a voice in the discussion around normative problems of innovative therapies. It particularly refers to problems related to the contribution of experimental therapies to the development of medical knowledge, also discussed in this issue in the article by Olga Dryla "Expanded access programs as a source of cognitive data.".

On 27 September 2013, the Centre for the Humanities and Health (CHH) at King's College London hosted a 1-day workshop on ‘Medical knowledge, Medical Duties’. This workshop was the fifth in a series of five workshops whose aim is to provide a new model for high-quality, open interdisciplinary engagement between medical professionals and philosophers. This report identifies the key points of discussion raised throughout the day and the methodology employed.

EMBARGOED - expected end date 06.06.2025.

There has been a modern epidemic of heart attacks in the western world, and this paper is concerned with this ‘new’ medical condition and how it arose. Two competing theories are commonly proposed, relating either to conventional accounts of medical science, or to social construction. Whilst recognising that aspects of both theories have some validity, it is claimed that neither is wholly adequate. This issue has particular relevance for heart attacks and is explored in some detail, but it (...) also points to some more general conclusions. First that medical knowledge cannot be separated into ‘scientific’ and ‘social’ compartments but is united by its human aspect; and second that although medical knowledge has a special dimension, when understood in this way, it may also resonate with a more general re-examination of the relationship between scientific and human knowledge. (shrink)

In considering whether medical miracles occur, the limits of epistemology bring us to confront our metaphysical worldview of medicine and nature in general. This raises epistemological questions of a higher order. David Hume’s understanding of miracles as violations of the laws of nature assumes that nature is completely regular, whereas doctrines such as C. S. Peirce’s "tychism" hold that there is an element of absolute chance in the workings of the universe. Process philosophy gives yet another view of the (...) working of nature. Physicians have no epistemological grounds for declaring any cure to be miraculous. Miracles are theological (or philosophical) entities, and not medical entities. All physicians can do is to determine whether or not a cure is scientifically inexplicable according to the current epistemological standards of medical science. (edited). (shrink)

Attempts to formalize the diagnostic process are by no means a recent undertaking; what is new is the availability of an engine to process these formalizations. The digital computer has therefore been increasingly turned to in the expectation of developing systems which will assist or replace the physician in diagnosis. Such efforts involve a number of assumptions regarding the nature of the diagnostic process: e.g. where it begins, and where it ends. ‘Diagnosis’ appears to include a number of quite different (...) cognitive processes, some of which seem more subject to formalization than others. Underlying the difficulties inherent in these efforts at formalization, is the hierarchical structure of medical knowledge including that of diseases. (By ‘hierarchical structure’, I mean no more than that our descriptions of clinical objects necessarily refer to different levels of organization; atomic, molecular, cellular, physiological system, entire patient.) Since diagnosis is in part a form of classification, measures of similarity between the clinical findings of a particular patient and a potential disease, are needed. This is complicated by the fact that some diseases are described using the vocabularies of physics and chemistry, others with the vocabulary of psychology, and most, with terms taken from a number of different hierarchical levels. The differences between the descriptions made using these vocabularies will be seen to exert systematic (if not uniform) influences upon the diagnostic process. CiteULike Connotea Del.icio.us What's this? (shrink)

According to Fleck, a fact is not something objectively given but rather a social event. Scientific facts are no exception, as can be seen through the annals of medicine. Fleck argues that if the physical sciences initially appear to be immune to such social conditioning, this misconception can be corrected by recognizing the similarities between the natural sciences and medicine both historically and epistemologically. Fleck's ideas are not new, having been presented by him in 1935, but it is only recently (...) that they have begun to strike a responsive chord. Kuhn was aware of Fleck's work when he began to promulgate his own ideas in the 1960s. But there are important differences as well as similarities which can only be appreciated once Fleck's own work has had a proper hearing. To this end the University of Chicago Press has published a translation-edition of the full monograph in 1979. In ‘On the question of the foundations of medical knowledge’, Fleck's own precis to this major work, he correctly foretold the dawning of the sociology of cognition. CiteULike Connotea Del.icio.us What's this? (shrink)

In China, the local communities and various ethnic minorities still hold, sustain and develop traditional medicial knowledge (TMK), innovations, and practices within the original communities. TMK also has pharmaceutical option value, which has attracted interests in commercial use of TMK for pharmaceutical innovation in China. However, the increased use of TMK for non-traditional purposes might lead to a change in the customary treatment of TMK as common goods of relevant communities and peoples, and may lead to significant tension faced (...) by both providers and users of TMK in China. We find there is a significant gap in literature analysing the phenonmenon of domestic biopolitics concerning TMK in China. Closely connected problem is the contradictory relationship between providers and users of TMK, especially between the indigenous and local communities, and corporate and industrial actors. Therefore, urgent research is needed to fill this literature gap. (shrink)

In China, the local communities and various ethnic minorities still hold, sustain and develop traditional medicial knowledge (TMK), innovations, and practices within the original communities. TMK also has pharmaceutical option value, which has attracted interests in commercial use of TMK for pharmaceutical innovation in China. However, the increased use of TMK for non-traditional purposes might lead to a change in the customary treatment of TMK as common goods of relevant communities and peoples, and may lead to significant tension faced (...) by both providers and users of TMK in China. We find there is a significant gap in literature analysing the phenonmenon of domestic biopolitics concerning TMK in China. Closely connected problem is the contradictory relationship between providers and users of TMK, especially between the indigenous and local communities, and corporate and industrial actors. Therefore, urgent research is needed to fill this literature gap. (shrink)

Despite medicine's achievements, medical errors and the difficulty of reproducing research prove medicine is far from perfect. This book provides a critical and historical analysis of medical reasoning that recognizes the constant need for certainty despite the enormous variety of disease, illness, symptoms, and behavior in patients. According to Erwin Montgomery, Jr., medicine depends on logic, balancing utility with certainty, and anticipating errors in judgment.

However much the three great traditions of medicine - Galenic, Chinese and Ayurvedic - differed from each other, they had one thing in common: scholarship. The foundational knowledge of each could only be acquired by careful study under teachers relying on ancient texts. Such medical knowledge is special, operating as it does in the realm of the most fundamental human experiences - health, disease, suffering, birth and death - and the credibility of healers is of crucial importance. (...) Because of this, scholarly medical knowledge offers a rich field for the study of different cultural practices in the legitimation of knowledge generally. The contributors to this volume are all specialists in the history or anthropology of these traditions, and their essays range from historical investigations to studies of present-day practices. (shrink)

This essay discusses the question of health in the Kingdom of Hungary during the Age of Enlightenment. It explores the relationships and tensions between central theories of medical police and the local expectations of government administrators, as well as those between academic or official knowledge and implicit or alternative knowledge about health. The reigns of Maria Theresia and Joseph II marked the moment at which particular kinds of folk and practical knowledge about healing became visible and (...) above all legible. This is to be seen in the enormous rise in book production, which in itself represented an ‘approved knowledge’ that found legitimation in new academic and bureaucratic institutions, such as the reformed medical faculty of the University of Vienna, the newly-founded medical faculty at Tyrnau, the establishment of a health department within the Hungarian Statthalterei, as well as in the emission of royal legislation supporting the agendas of the new enlightened science of ‘medical police’. (shrink)

To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan.