Having blogged earlier today about philosophy, history and medicine, I’ve settled on an altered abstract for my upcoming inaugural. It’s below.
Anyone wanting an invite but who hasn’t received one by the end of this week should feel free to contact me directly and I’ll see if I can add you to the invite list. It’s 2 August.
Prediction and Medicine (Abstract)
What is medicine? In the context of the contemporary Western tradition, it is easy to suppose that medicine is the process of treating a sick person’s body, or mind, so as to make it better—or something like that, suitably adapted to take care of cosmetic surgery and so forth. But even so adapted, this “curative thesis” is not satisfactory. Historian of medicine Roy Porter maintains that the position of medicine in society has had, and still has, little to do with its ability to make people better. Perhaps Western medicine is uniquely capable at curing individuals given adequate resources, but it is very far from perfection even in these terms, as philosopher Jacob Stegenga has recently argued in urging “medical nihilism”. And its efficacy at improving population health has been famously doubted by historians and epidemiologists (hygiene, nutrition, wealth and peace being more effective). When we look at non-Western and older Western medicine, we see that Western medicine is unique in another way, in proffering explanations in terms of the individual body and, perhaps, mind. Most other traditions see disease as more widely significant, of sickness in the body politic (e.g. “the state of Denmark”), displeasure of ancestors of gods, malicious forces, imbalances in the natural order, and so forth. The “curative thesis” demands that we have mostly been stupid, duped, or staggeringly hopeful, given that medicine has not until recently and locally offered more than a handful of effective cures; and it ignores the connection of medicine with cosmic matters that is characteristic of most medicine. I suggest, in this lecture, that the core medical competence is not to cure, nor to prevent, but to predict disease. The predictions expected of doctors are both actual and counterfactual: both “When will I get better?” and “What would have happened if I had not taken my medicine?”. This “predictive thesis” does a better job than the “curative thesis” at explaining why not all medicine is concerned with curative efforts, and it enjoys considerable historical support from the ancient entanglement of prophesy and medicine and from the fact that medicine thrived for centuries with almost no effective cures, and continues to thrive today in various forms that are mostly without curative efficacy, perhaps also enabling a fairer approach to alternative, traditional, and other medical practices. I also argue that it relieves medicine of the pretences of potency that generate the righteous indignation implicit in the arguments for medical nihilism. I also ask whether this descriptive thesis about the nature of medicine offers any prescriptions, or lessons, for the development of medicine.