Changes

The '''philosophy of medicine''' is a branch of [[Wikipedia:philosophy|philosophy]] that explores issues in theory, research, and practice within the field of health sciences.<ref>{{Cite book|url=https://philpapers.org/rec/WULPOM-2|title=Philosophy of Medicine an Introduction|last1=Wulff|first1=Henrik R.|last2=Pedersen|first2=Stig Andur|last3=Rosenberg|first3=Raben|date=1986}}</ref> More specifically in topics of [[Wikipedia:epistemology|epistemology]], [[Wikipedia:metaphysics|metaphysics]], and [[Wikipedia:medical ethics|medical ethics]], which overlaps with [[Wikipedia:bioethics|bioethics]]. Philosophy and medicine, both beginning with the ancient Greeks, have had a long history of overlapping ideas. It was not until the nineteenth century that the professionalization of the philosophy of medicine came to be.<ref>{{Cite journal|last1=Ankeny|first1=Rachel A.|last2=Reiss|first2=Julian|date=2016-06-06|title=Philosophy of Medicine|url=https://plato.stanford.edu/archives/sum2016/entries/medicine/}}</ref> In the late twentieth century debates among philosophers and physicians ensued of whether or not the philosophy of medicine should be considered a field of its own from either philosophy or medicine.<ref>{{Cite journal|last=Caplan|first=Arthur L.|date=March 1992|title=Does the philosophy of medicine exist?|journal=Theoretical Medicine|volume=13|issue=1|pages=67–77|doi=10.1007/BF00489220|pmid=1604434|s2cid=22710233|issn=0167-9902}}</ref> A consensus has since been reached that it is in fact a distinct discipline with its set of separate problems and questions. In recent years there have been a variety of university courses,<ref>[https://www.dur.ac.uk/philosophy/research/research_centres/hpsmgroup/ Durham University History and Philosophy of Medicine]</ref><ref>[http://www.conted.ox.ac.uk/B900-77 University of Oxford course on the History and Philosophy of Medicine]</ref> journals,<ref>[https://www.springer.com/medicine/journal/11019 Springer Journal, Medicine, Health Care, and Philosophy]</ref><ref>[https://web.archive.org/web/20080509055028/http://jmp.oxfordjournals.org/ Oxford Journals, Journal of Medicine and Philosophy]</ref><ref>[https://www.springer.com/philosophy/epistemology+and+philosophy+of+science/journal/11017 Springer Journal, Theoretical Medicine and Bioethics]</ref><ref>{{cite journal | author = Pijush Kanti Bhattacharjee | year = 2014 | title = Working Philosophy of All Medicines | journal = International Journal of Advanced Engineering and Global Technology | volume = 2 | issue = 7| pages = 823–827 | url = http://ijaegt.com/wp-content/uploads/2014/07/IJAEGT-409192-Page-823-827-Pijush-updated.pdf}}</ref> books,<ref>{{cite book| author = Dov M. Gabbay| title = Philosophy of Medicine| url = http://www.sciencedirect.com/science/book/9780444517876| date = 2011-02-23| publisher = Science Direct| isbn = 978-0-444-51787-6}}</ref><ref name="Jeremy Howick">{{cite book| author = Jeremy Howick| title = The Philosophy of Evidence-based Medicine| url = https://books.google.com/books?id=O8djbHBva5IC&pg=PA15| date = 2011-02-23| publisher = John Wiley & Sons| isbn = 978-1-4443-4266-6}}</ref><ref>{{cite book| author = Edmund D. Pellegrino| title = The Philosophy of Medicine Reborn| url = http://undpress.nd.edu/book/P01232/| publisher = University of Notre Dame Press}}</ref><ref>{{cite journal| author = Keekok Lee| title = The Philosophical Foundations of Modern Medicine| journal = Theoretical Medicine and Bioethics| volume = 34| issue = 5| pages = 437–440| date = 2013-02-23| doi = 10.1007/s11017-013-9253-5| s2cid = 141742194}}</ref> textbooks<ref>{{Cite book|title=Care and Cure: An Introduction To Philosophy of Medicine|last=Stegenga|first=Jacob|publisher=University of Chicago Press|year=2018|isbn=9780226595030| url = https://www.press.uchicago.edu/ucp/books/book/chicago/C/bo29193227.html}}</ref> and conferences dedicated to the philosophy of medicine. There is also a new direction, or school, in the philosophy of medicine termed [[Wikipedia:Kazem Sadegh-Zadeh|analytic philosophy of medicine]].

The '''philosophy of medicine''' is a branch of [[Wikipedia:philosophy|philosophy]] that explores issues in theory, research, and practice within the field of health sciences.<ref>{{Cite book|url=https://philpapers.org/rec/WULPOM-2|title=Philosophy of Medicine an Introduction|last1=Wulff|first1=Henrik R.|last2=Pedersen|first2=Stig Andur|last3=Rosenberg|first3=Raben|date=1986}}</ref> More specifically in topics of [[Wikipedia:epistemology|epistemology]], [[Wikipedia:metaphysics|metaphysics]], and [[Wikipedia:medical ethics|medical ethics]], which overlaps with [[Wikipedia:bioethics|bioethics]]. Philosophy and medicine, both beginning with the ancient Greeks, have had a long history of overlapping ideas. It was not until the nineteenth century that the professionalization of the philosophy of medicine came to be.<ref>{{Cite journal|last1=Ankeny|first1=Rachel A.|last2=Reiss|first2=Julian|date=2016-06-06|title=Philosophy of Medicine|url=https://plato.stanford.edu/archives/sum2016/entries/medicine/}}</ref> In the late twentieth century debates among philosophers and physicians ensued of whether or not the philosophy of medicine should be considered a field of its own from either philosophy or medicine.<ref>{{Cite journal|last=Caplan|first=Arthur L.|date=March 1992|title=Does the philosophy of medicine exist?|journal=Theoretical Medicine|volume=13|issue=1|pages=67–77|doi=10.1007/BF00489220|pmid=1604434|s2cid=22710233|issn=0167-9902}}</ref> A consensus has since been reached that it is in fact a distinct discipline with its set of separate problems and questions. In recent years there have been a variety of university courses,<ref>[https://www.dur.ac.uk/philosophy/research/research_centres/hpsmgroup/ Durham University History and Philosophy of Medicine]</ref><ref>[http://www.conted.ox.ac.uk/B900-77 University of Oxford course on the History and Philosophy of Medicine]</ref> journals,<ref>[https://www.springer.com/medicine/journal/11019 Springer Journal, Medicine, Health Care, and Philosophy]</ref><ref>[https://web.archive.org/web/20080509055028/http://jmp.oxfordjournals.org/ Oxford Journals, Journal of Medicine and Philosophy]</ref><ref>[https://www.springer.com/philosophy/epistemology+and+philosophy+of+science/journal/11017 Springer Journal, Theoretical Medicine and Bioethics]</ref><ref>{{cite journal | author = Pijush Kanti Bhattacharjee | year = 2014 | title = Working Philosophy of All Medicines | journal = International Journal of Advanced Engineering and Global Technology | volume = 2 | issue = 7| pages = 823–827 | url = http://ijaegt.com/wp-content/uploads/2014/07/IJAEGT-409192-Page-823-827-Pijush-updated.pdf}}</ref> books,<ref>{{cite book| author = Dov M. Gabbay| title = Philosophy of Medicine| url = http://www.sciencedirect.com/science/book/9780444517876| date = 2011-02-23| publisher = Science Direct| isbn = 978-0-444-51787-6}}</ref><ref name="Jeremy Howick">{{cite book| author = Jeremy Howick| title = The Philosophy of Evidence-based Medicine| url = https://books.google.com/books?id=O8djbHBva5IC&pg=PA15| date = 2011-02-23| publisher = John Wiley & Sons| isbn = 978-1-4443-4266-6}}</ref><ref>{{cite book| author = Edmund D. Pellegrino| title = The Philosophy of Medicine Reborn| url = http://undpress.nd.edu/book/P01232/| publisher = University of Notre Dame Press}}</ref><ref>{{cite journal| author = Keekok Lee| title = The Philosophical Foundations of Modern Medicine| journal = Theoretical Medicine and Bioethics| volume = 34| issue = 5| pages = 437–440| date = 2013-02-23| doi = 10.1007/s11017-013-9253-5| s2cid = 141742194}}</ref> textbooks<ref>{{Cite book|title=Care and Cure: An Introduction To Philosophy of Medicine|last=Stegenga|first=Jacob|publisher=University of Chicago Press|year=2018|isbn=9780226595030| url = https://www.press.uchicago.edu/ucp/books/book/chicago/C/bo29193227.html}}</ref> and conferences dedicated to the philosophy of medicine. There is also a new direction, or school, in the philosophy of medicine termed [[Wikipedia:Kazem Sadegh-Zadeh|analytic philosophy of medicine]].

==Epistemology ==

==Epistemology==

Epistemology is a branch in the philosophy of medicine that is concerned with knowledge.<ref>{{Cite web|url=https://www.britannica.com/topic/epistemology|title=epistemology {{!}} Definition, Nature, Problems, & History|website=Encyclopedia Britannica|access-date=2019-05-01}}</ref> The common questions asked are "What is knowing or knowledge?", "How do we know what we know?", "What is it we know when we claim we know".<ref>{{Cite book|url=https://books.google.com/books?id=3DPNR2AFpkoC&q=Epistemology+and+the+Psychology+of+Human+Judgment&pg=PR11|title=Epistemology and the Psychology of Human Judgment|last1=Bishop|first1=Michael A.|last2=Trout|first2=J. D.|last3=Trout|first3=Professor of Philosophy and Psychology J. D.|date=2005|publisher=Oxford University Press, USA|isbn=9780195162295}}</ref> Philosophers differentiate theories of knowledge into three groups: knowledge of acquaintance, competence knowledge, and propositional knowledge. The knowledge of acquaintance is to be familiar with an object or event. To best explain this would be, a surgeon would need to know the human anatomy before operating on the body. Competence of knowledge is to use known knowledge to perform a task skillfully. The surgeon must know how to perform the surgical procedure before executing it. Propositional knowledge is explanatory, it pertains to certain truths or facts. If the surgeon is performing on the heart it must know the physiological function of the heart before the surgery is performed.<ref>{{Cite journal|last=Khushf|first=George|date=2013-10-01|title=A Framework for Understanding Medical Epistemologies|url=https://academic.oup.com/jmp/article/38/5/461/899502|journal=The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine|volume=38|issue=5|pages=461–486|doi=10.1093/jmp/jht044|pmid=24038643|issn=0360-5310}}</ref>

Epistemology is a branch in the philosophy of medicine that is concerned with knowledge.<ref>{{Cite web|url=https://www.britannica.com/topic/epistemology|title=epistemology {{!}} Definition, Nature, Problems, & History|website=Encyclopedia Britannica|access-date=2019-05-01}}</ref> The common questions asked are "What is knowing or knowledge?", "How do we know what we know?", "What is it we know when we claim we know".<ref>{{Cite book|url=https://books.google.com/books?id=3DPNR2AFpkoC&q=Epistemology+and+the+Psychology+of+Human+Judgment&pg=PR11|title=Epistemology and the Psychology of Human Judgment|last1=Bishop|first1=Michael A.|last2=Trout|first2=J. D.|last3=Trout|first3=Professor of Philosophy and Psychology J. D.|date=2005|publisher=Oxford University Press, USA|isbn=9780195162295}}</ref> Philosophers differentiate theories of knowledge into three groups: knowledge of acquaintance, competence knowledge, and propositional knowledge. The knowledge of acquaintance is to be familiar with an object or event. To best explain this would be, a surgeon would need to know the human anatomy before operating on the body. Competence of knowledge is to use known knowledge to perform a task skillfully. The surgeon must know how to perform the surgical procedure before executing it. Propositional knowledge is explanatory, it pertains to certain truths or facts. If the surgeon is performing on the heart it must know the physiological function of the heart before the surgery is performed.<ref>{{Cite journal|last=Khushf|first=George|date=2013-10-01|title=A Framework for Understanding Medical Epistemologies|url=https://academic.oup.com/jmp/article/38/5/461/899502|journal=The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine|volume=38|issue=5|pages=461–486|doi=10.1093/jmp/jht044|pmid=24038643|issn=0360-5310}}</ref>

Modern medicine, unlike [[Wikipedia:Galen|Galenic medicine]] (which dealt with [[Wikipedia:humours|humours]]), is [[Wikipedia:Mechanical philosophy|mechanistic]]. For example, when a bit of solid matter such as a poison or a worm impacts upon another bit of matter (when it enters the human body), this sets off a chain of motions, giving rise to disease, just as when one billiard ball knocks into another billiard, the latter is set in motion. When the human body is exposed to the solid pathogen, it falls ill, giving rise to the notion of a disease entity. Later in the history of modern medicine, particularly by the late nineteenth and twentieth centuries, in nosology (which is the classification of disease), the most powerful is the etiogically-defined approach as can be found in the monogenic conception of disease which covers not only infectious agents (bacteria, viruses. fungi, parasites, prions) but also genetics, poisons. While clinical medicine is concerned with the ill health of the individual patient when s/he has succumbed to disease, epidemiology is concerned with the pattern of diseases in populations in order to study their causes as well as how to manage, control, ameliorate the problems identified under study.

Modern medicine, unlike [[Wikipedia:Galen|Galenic medicine]] (which dealt with [[Wikipedia:humours|humours]]), is [[Wikipedia:Mechanical philosophy|mechanistic]]. For example, when a bit of solid matter such as a poison or a worm impacts upon another bit of matter (when it enters the human body), this sets off a chain of motions, giving rise to disease, just as when one billiard ball knocks into another billiard, the latter is set in motion. When the human body is exposed to the solid pathogen, it falls ill, giving rise to the notion of a disease entity. Later in the history of modern medicine, particularly by the late nineteenth and twentieth centuries, in nosology (which is the classification of disease), the most powerful is the etiogically-defined approach as can be found in the monogenic conception of disease which covers not only infectious agents (bacteria, viruses. fungi, parasites, prions) but also genetics, poisons. While clinical medicine is concerned with the ill health of the individual patient when s/he has succumbed to disease, epidemiology is concerned with the pattern of diseases in populations in order to study their causes as well as how to manage, control, ameliorate the problems identified under study.

Clinical medicine, as presented above, is part of a reductionist approach to disease, based ultimately on Cartesian dualism which says that the proper study of medicine is an investigation of the body when the latter is viewed as machine. A machine can exhaustively be broken down into its component parts and their respective functions; in the same way, the dominant approach to clinical research and treatment assumes the human body can be broken down/analysed in terms of its component parts and their respective functions, such as its internal and external organs, the tissues and bones of which they are composed, the cells which make up the tissues, the molecules which constitute the cell, down to the atoms (the DNA sequences) which make up the cell in the body.

Clinical medicine, as presented above, is part of a [[Reductionism|reductionist]] approach to disease, based ultimately on Cartesian dualism which says that the proper study of medicine is an investigation of the body when the latter is viewed as machine. A machine can exhaustively be broken down into its component parts and their respective functions; in the same way, the dominant approach to clinical research and treatment assumes the human body can be broken down/analysed in terms of its component parts and their respective functions, such as its internal and external organs, the tissues and bones of which they are composed, the cells which make up the tissues, the molecules which constitute the cell, down to the atoms (the DNA sequences) which make up the cell in the body.

====Placebo====

====Placebo====

The problems arising over the definition of placebos and their effects may be said to be the heritage of Cartesian dualism, under which mind and matter are understood as two different substances. Furthermore, Cartesian dualism endorses a form of materialism which permits matter to have an effect on matter, or even matter to work on mind (epiphenomenalism, which is the raison d’être of psycho-pharmacology), but does not permit mind to have any effect on matter. This then means that medical science has difficulty in entertaining even the possibility that placebo effects are real, exist and may be objectively determinable and finding such reports difficult if not impossible to comprehend and/or accept. Yet such reports which appear to be genuine pose a threat to Cartesian dualism which provides the ontological underpinning for biomedicine especially in its clinical domain.<ref name="Lee 2012" />

The problems arising over the definition of placebos and their effects may be said to be the heritage of Cartesian dualism, under which mind and matter are understood as two different substances. Furthermore, Cartesian dualism endorses a form of materialism which permits matter to have an effect on matter, or even matter to work on mind (epiphenomenalism, which is the raison d’être of psycho-pharmacology), but does not permit mind to have any effect on matter. This then means that medical science has difficulty in entertaining even the possibility that placebo effects are real, exist and may be objectively determinable and finding such reports difficult if not impossible to comprehend and/or accept. Yet such reports which appear to be genuine pose a threat to Cartesian dualism which provides the ontological underpinning for biomedicine especially in its clinical domain.<ref name="Lee 2012" />

== How Physicians Practice Medicine ==

==How Physicians Practice Medicine==

===Evidence-based medicine===

===Evidence-based medicine===

[[Wikipedia:Evidence-based medicine|Evidence-based medicine]] (EBM) is underpinned by the study of the ways in which we can gain knowledge regarding key clinical questions such as the effects of medical interventions, the accuracy of diagnostic tests, and the predictive value of prognostic markers. EBM provides an account of how medical knowledge can be applied to clinical care. EBM not only provides clinicians with a strategy for best [[Wikipedia:Evidence-based practice|practice]], but also, underlying that, a philosophy of evidence.

[[Wikipedia:Evidence-based medicine|Evidence-based medicine]] (EBM) is underpinned by the study of the ways in which we can gain knowledge regarding key clinical questions such as the effects of medical interventions, the accuracy of diagnostic tests, and the predictive value of prognostic markers. EBM provides an account of how medical knowledge can be applied to clinical care. EBM not only provides clinicians with a strategy for best [[Wikipedia:Evidence-based practice|practice]], but also, underlying that, a philosophy of evidence.

Interest in the EBM philosophy of evidence has led philosophers to consider the nature of EBM’s [[Wikipedia:hierarchy of evidence|hierarchy of evidence]], which rank different kinds of research methodology, ostensibly, by the relative evidential weight they provide. While [[Wikipedia:Jeremy Howick|Jeremy Howick]] provides a critical defense of EBM,<ref name="Jeremy Howick"/> most philosophers have raised questions about its legitimacy. Key questions asked about hierarchies of evidence concern the legitimacy of ranking methodologies in terms of the strength of support that they supply;<ref name="La Caze 2008">{{cite journal|author=La Caze A|year=2008|title=Evidence-Based Medicine Can't Be…|journal=Social Epistemology|volume=22|issue=4|pages=353–379|doi=10.1080/02691720802559438}}</ref><ref name="La Caze 2009">{{cite journal|author=La Caze A|year=2009|title=Evidence-Based Medicine Must Be …|journal=Journal of Medicine and Philosophy|volume=34|issue=5|pages=509–527|doi=10.1093/jmp/jhp034|pmid=19690324}}</ref> how instances of particular methods may move up and down a hierarchy;<ref name="Guyatt et al 2008">{{cite journal|author=Guyatt G.H.|display-authors=etal|year=2008|title=GRADE: an emerging consensus on rating quality of evidence and strength of recommendations|journal=British Medical Journal|volume=336|issue=7650|pages=924–6|doi=10.1136/bmj.39489.470347.AD|pmc=2335261|pmid=18436948}}</ref>  as well as how different types of evidence, from different levels in the hierarchies, should be combined. Critics of medical research have raised numerous questions regarding the unreliability of medical research.<ref>{{citation|author=Jacob Stegenga|title=Medical Nihilism|url=https://global.oup.com/academic/product/medical-nihilism-9780198747048?cc=hr&lang=en&|year=2018|publisher=OUP|isbn=9780198747048}}</ref>

Interest in the EBM philosophy of evidence has led philosophers to consider the nature of EBM’s [[Wikipedia:hierarchy of evidence|hierarchy of evidence]], which rank different kinds of research methodology, ostensibly, by the relative evidential weight they provide. While [[Wikipedia:Jeremy Howick|Jeremy Howick]] provides a critical defense of EBM,<ref name="Jeremy Howick" /> most philosophers have raised questions about its legitimacy. Key questions asked about hierarchies of evidence concern the legitimacy of ranking methodologies in terms of the strength of support that they supply;<ref name="La Caze 2008">{{cite journal|author=La Caze A|year=2008|title=Evidence-Based Medicine Can't Be…|journal=Social Epistemology|volume=22|issue=4|pages=353–379|doi=10.1080/02691720802559438}}</ref><ref name="La Caze 2009">{{cite journal|author=La Caze A|year=2009|title=Evidence-Based Medicine Must Be …|journal=Journal of Medicine and Philosophy|volume=34|issue=5|pages=509–527|doi=10.1093/jmp/jhp034|pmid=19690324}}</ref> how instances of particular methods may move up and down a hierarchy;<ref name="Guyatt et al 2008">{{cite journal|author=Guyatt G.H.|display-authors=etal|year=2008|title=GRADE: an emerging consensus on rating quality of evidence and strength of recommendations|journal=British Medical Journal|volume=336|issue=7650|pages=924–6|doi=10.1136/bmj.39489.470347.AD|pmc=2335261|pmid=18436948}}</ref>  as well as how different types of evidence, from different levels in the hierarchies, should be combined. Critics of medical research have raised numerous questions regarding the unreliability of medical research.<ref>{{citation|author=Jacob Stegenga|title=Medical Nihilism|url=https://global.oup.com/academic/product/medical-nihilism-9780198747048?cc=hr&lang=en&|year=2018|publisher=OUP|isbn=9780198747048}}</ref>

Additionally the epistemological virtues of particular aspects of [[Wikipedia:clinical trial|clinical trial]] methodology have been examined, mostly notably the special place that is given to [[Wikipedia:randomisation|randomisation]],<ref name="Papineau 1994">{{cite journal|author=Papineau D|year=1994|title=The Virtues of Randomization|journal=British Journal for the Philosophy of Science|volume=45|issue=2|pages=437–450|doi=10.1093/bjps/45.2.437}}</ref><ref name="Worrall 2002">{{cite journal | author = Worrall J | year = 2002 | title = What Evidence in Evidence-Based Medicine? | journal = Philosophy of Science | volume = 69 | issue = 3| pages = S316–S330 | doi = 10.1086/341855 | jstor = 3081103 | s2cid = 55078796 }}</ref><ref name="Worrall 2007">{{cite journal|author=Worrall J|year=2007|title=Why there's no cause to randomize|journal=British Journal for the Philosophy of Science|volume=58|issue=3|pages=451–488|citeseerx=10.1.1.120.7314|doi=10.1093/bjps/axm024}}</ref> the notion of a [[Wikipedia:blind experiment|blind experiment]] and the use of a [[Wikipedia:placebo control|placebo control]].

Additionally the epistemological virtues of particular aspects of [[Wikipedia:clinical trial|clinical trial]] methodology have been examined, mostly notably the special place that is given to [[Wikipedia:randomisation|randomisation]],<ref name="Papineau 1994">{{cite journal|author=Papineau D|year=1994|title=The Virtues of Randomization|journal=British Journal for the Philosophy of Science|volume=45|issue=2|pages=437–450|doi=10.1093/bjps/45.2.437}}</ref><ref name="Worrall 2002">{{cite journal | author = Worrall J | year = 2002 | title = What Evidence in Evidence-Based Medicine? | journal = Philosophy of Science | volume = 69 | issue = 3| pages = S316–S330 | doi = 10.1086/341855 | jstor = 3081103 | s2cid = 55078796 }}</ref><ref name="Worrall 2007">{{cite journal|author=Worrall J|year=2007|title=Why there's no cause to randomize|journal=British Journal for the Philosophy of Science|volume=58|issue=3|pages=451–488|citeseerx=10.1.1.120.7314|doi=10.1093/bjps/axm024}}</ref> the notion of a [[Wikipedia:blind experiment|blind experiment]] and the use of a [[Wikipedia:placebo control|placebo control]].

==External links==

==External links==

* [http://www.iep.utm.edu/medicine/ Philosophy of Medicine] article in the ''[[Wikipedia:Internet Encyclopedia of Philosophy|Internet Encyclopedia of Philosophy]]''

 

* [https://www.people.hps.cam.ac.uk/index/teaching-officers/stegenga/stegenga-syllabus-lower] Syllabus for teaching Philosophy of Medicine

*[http://www.iep.utm.edu/medicine/ Philosophy of Medicine] article in the ''[[Wikipedia:Internet Encyclopedia of Philosophy|Internet Encyclopedia of Philosophy]]''

*[https://www.people.hps.cam.ac.uk/index/teaching-officers/stegenga/stegenga-syllabus-lower] Syllabus for teaching Philosophy of Medicine

{{Philosophy topics}}

{{Philosophy topics}}