I’m committed to producing draft chapters of my book “Philosophy of Medicine” (under contract with Oxford) over the coming three months, since it’s being used for to teach a course. I would appreciate any other readers, for part or whole, and if you would like to receive draft chapters as I go along, please let me know. Here’s an outline with dates the drafts will be ready. I’m also attaching the 2 page preface: About This Book.
Chapter 1: What Is Philosophy of Medicine? (3 Jan) sets out the approach of the book. It suggests that many topics in the Philosophy of Medicine can be seen as contributing, more or less directly, towards answering the question “What is medicine?” The chapter also introduces my idea about the answer, which is the Inquiry Thesis: that medicine is an inquiry into health and illness, and the reasons for them. The chapter sets out some methodological ideas, arguing that conceptual analysis alone is inadequate for Philosophy of Medicine, and emphasizing the importance of historical, sociological and anthropological awareness. The Chapter also includes a cursory historical survey of medicine.
Chapter 2: Medical Competence (10 Jan) asks what medical professionals do, that distinguishes them from other professionals. In this Chapter I develop my idea that medicine is an inquiry, and argue that medicine cannot be fully understood merely as the business of delivering cure.
Chapter 3: Evidence Based Medicine (17 Jan) considers the movement known by that name, arising in the 1990s. The Chapter considers both the EBM’s critiques of Mainstream Medical practice, and the various philosophical, scientific, and medical attacks on EBM. The analysis offered is that social factors were among the primary drivers in this debate, and remain prominent in its aftermath.
Chapter 4: Person-Centred Medicine (due 24 Jan) considers the idea that Mainstream Medicine wrongly focuses on the disease at the expense of the patient, or person. There are several drivers for this idea, including resistance to EBM, the hope held out by genetic advances of tailoring treatments to individuals, and good old Hippocratic attitudes. The Chapter seeks to untangle the drivers and make sense of the prescriptions of the movement.
Chapter 5: Medical Nihilism (31 Jan) considers the view that medicine is largely useless. The view was common in the days when medicine really was largely ineffective, but less common now. However it has received continued defense from both historians and philosophers. We will consider contemporary arguments for and against the view.
Chapter 6: Alternatives (7 Feb) addresses the widespread consultation of non-Mainstream traditions within Western contexts. These are often motivated by nihilism about Mainstream Medicine. Alternative therapies are politically contentious, and there are many commentators who dismiss all such therapists as quacks, and their patients as idiots. The chapter seeks a balanced understanding of the continued appeal of alternatives, by obtaining a clearer understanding of the epistemological situation of the patient.
Chapter 7: Decolonising Medicine (14 Feb) discusses medical traditions in non-Western contexts other than Mainstream Medicine. These typically predate Mainstream Medicine, but they also change considerably with time. Attention is given both to learned traditions and those that are not or generally were not written down. Particular attention is given to the sangoma of southern Africa. The fact that Mainstream Medicine enjoys certain notable successes does not remove the fact that it is shaped by a particular culture, and that it implies power relations. The Chapter seeks to understand how to steer between cultural domination, on one hand, and a loose and impractical kind of relativism on the other.
Chapter 8: Epidemiology (28 Feb) discusses the significance of this relative minnow of health sciences. Existing outside the laboratory, and coming to formality only recently, epidemiology nevertheless has played a crucial role in some of the most significant health events since the medical revolution, notably the discovery that smoking causes lung cancer. This Chapter discusses its character and its internal wrangles, especially concerning causal inference outside the laboratory setting.
Chapter 9: Social Determinants of Health (7 Mar) explores one major consequence of contemporary epidemiological research, namely the demonstration that the way society is organised plays a major role in determining health. This discovery is threatening in a number of ways, since it blurs the distinction between medicine and politics, and undermines the significance of clinical medicine for population health. The Chapter considers the arguments for and against the causal claims at stake, and draws out some of their consequences.
Chapter 10: The Nature of Health (14 Mar) considers what health is, something that must be understood if medicine is to be understood. The Chapter surveys the philosophical literature on this topic, including the standard objections to the standard views, and suggests that the way to untangle the debate is to distinguish between evaluative and realist dimensions of debate. A position according to which health is akin to a “secondary property” is also defended.
Chapter 11: Disease and Classification (21 Mar) considers what disease is. The Chapter argues that disease is not the mere absence of health (contrary to the literature treated in Chapter 10), since such a definition would render talk of different diseases nonsensical. The Chapter explores the importance of differentiation between diseases for medicine, and discusses the significance of the continued difficulties in classifying psychological diseases.
Chapter 12: What is Medicine? (28 Mar) returns to the guiding question of this book, and sets out to defend and supplement the Inquiry Thesis.