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Medicine and the philosophy of science
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Plus de University of Amsterdam and University College London
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- 1. Medicine and the Philosophy of Science Federica Russo Philosophy | Humanities | Amsterdam russofederica.wordpress.com | @federicarusso
- 2. Staff for a New University @rethinkuva Rethink UvA 2
- 3. Overview What Medicine? What Philosophy of Science? Causation in phil sci and in medicine Networks of concepts, mosaics 3
- 4. MEDICINE 4
- 5. Medicine in the broadest terms Include all clinical, scientific, and political forms of engagement with health and disease Not just biomedicine Not just EBM 5
- 6. Medicine as a ‘disunion’ Include forms of practice sometimes not recognised as ’medicine’, e.g.: Clinical practice, including primary care and hospital medicine Preventive medicine and public health (more policy-oriented) Epidemiology Aim to capture major theories and approaches, including: Evidence-based practice and associated practice like guideline development and evidence reviews Narrative medicine Personalised medicine Gender medicine 6
- 8. Approaches to the sciences Analytic phil sci HPS / PSP / CitS / PI Sociology of science / STS Critical and interpretive approaches … 8
- 9. MEDICINE BELONGS TO SCIENCE 9
- 10. (Some) phil sci questions in medicine The method Modes of explanation Sources of evidence Knowledge and action 10
- 11. The end of RCT predominance? The quantitative turn in medicine (and beyond) Any role for qualitative observations and studies? Integration rather than competition? 11
- 12. What kind of phenomena are health & disease? The biologisation, molecularisation, and personalisation of disease Any role for social, psychological, behavioural factors? Integration rather than distinction? 12
- 13. Conceptualising and explaining health & disease Aetiology Causes of disease, of recovery, of well being (Causal) Mechanisms Of disease development, of drug action, of the individual’s environment 13
- 14. Where we should we get the relevant information? Surveys, interviews, case reports, … Evidence of Correlation / difference-making Mechanisms (functioning) 14
- 15. What you do if you knew that… ‘How much’ must / should we Establish before claiming that we understand Health, disease, treatments Know before we take appropriate action Individual treatments and public health interventions Wait before we implement changes Adverse drug reactions, ineffective treatments, … 15
- 16. CAUSALITY 16
- 17. Phil Sci approaches to causality A straightjacket to bridle phenomena? Traditional accounts In search of univocal definitions Applicable anywhere Or a lens through which reading scientific methods? CitS / PSP / PI In search for networks of concepts Respond to scientific / philosophical / societal challenges 17
- 18. Philosophical fields expanding Philosophy of medicine From medical ethics and definition of disease to epistemology and methodology of medicine Philosophy of causation From finding THE ONE definition of causation to understanding the role of causal notions in several scientific practices Causation in medicine: Provide an understanding of many ways in which medicine studies and intervenes on causes and effects of health and disease 18
- 20. Causal mosaics A reconstruction of how causal questions arise in medicine Making philosophical / methodological / practical sense of them 20
- 21. What does it look like? A dynamic picture that includes ‘tiles’ about: Scientific challenges Inference, explanation, prediction, control, reasoning Philosophical questions Metaphysics, epistemology, methodology, semantics, use Specific accounts Counterfactuals, mechanisms, processes, probabilities, information, agency, INUS, variation, regularity, … 21
- 22. 3: (SOME) CAUSAL THEORIES © Clarke & Russo 22Causation in Medicine Inference, Prediction, Explanation, Control, Reasoning Tiles For a Causal Mosaic Metaphysics, Semantics, Epistemology, Methodology, Use Necessary and sufficient Levels Evidence Probabilistic causality Counter- factuals Manipula- tion Invariance Exogeneity Simpson’s Paradox ProcessMechanism Information Dispositions Regularity Variation Action Inference Validity Truth
- 24. None does! We need to understand how they are connected 24
- 25. EVALUATING MECHANISMS IN MEDICINE AHRC project 25
- 26. Research Questions Overarching research question [Q]: How can evidence of mechanisms be considered alongside evidence of correlation to evaluate causal claims in medical research and health policy? The answer to this overarching question will build on answers to following questions: [EM: Evidence of Mechanisms]: What is evidence of a mechanism, and how do we get it? [QE: Quality of Evidence]: How can quality of evidence be characterised? [PC: Philosophy of Causality]: Which accounts of causality best fit the programme for integrating evidence of mechanisms with evidence of correlation? 26
- 27. People Christian Wallmann, Michael Wilde, Jon Williamson Centre for Reasoning, University of Kent Brendan Clarke, Donald Gillies, Phyllis Illari Department of Science and Technology Studies, University College London (UCL) Federica Russo Department of Philosophy, University of Amsterdam (UvA) Partners The National Institute for Health and Clinical Excellence (NICE) The International Agency for Research on Cancer (IARC) The Institute of Public Health at Cambridge University The Medical School at Leiden University 27
- 28. TO SUM UP AND CONCLUDE 28
- 29. Expanding domains Philosophy of Science Beyond – and back – to more inclusive ways of studying science (Philosophy of) Medicine Beyond questions about ethics, closer to concerns of phil sci 29
- 30. A convergence of interests Medicine and the Philosophy of Science Methods and concepts of medicine • RCTs, mechanisms, evidence, … Conceptualisations of health & disease • Bio-social phenomena, … Societal relevance • The value of the humanities, … 30
Notes de l'éditeur
- In the last decade or so philosophers of science started paying attention to medicine, broadly construed. Before, medicine was primarily in the target of ethicists or anthropologists, but not so much philosophers of science. Conversely, philosophy of science was - before - occupied with questions arising in the natural sciences and, to a lesser extent, to the social sciences. In this talk I offer an overview of the main questions occupying the debate and I explain why this turn in philosophy of science is noteworthy.
- Motivate need to discuss ‘causation in medicine’. Understanding it with respect to the crossing of two fields: phil med and phil cause I’d like to make a comment here about things that philmed in general could usefully acquire from causation in medicine. Definitions of disease as paradigm case (after Caplan): neither of interest to practitioners, nor philosophers more generally.