Philosophy for a better medicine

Subtitle:conceptual and epistemological issues of disease and medical treatment

This dissertation is concerned with conceptual, epistemological, and by extension, ethical, issues in medicine. In Chapter 1, I start by exploring the concept of disease—a foundational and long-debated issue in the philosophy of medicine. Here I clarify important aspects of a well-developed naturalist account of disease—the biostatistical theory (BST)—and articulate an extension to the BST that shows how it is relevant to clinical medicine on a practical level. In Chapter 2, I further demonstrate the usefulness of the BST by showing how the way it conceives of disease can contribute to formation of a typology of clinical conditions, which I argue can help make sense of various conceptual issues in medicine. Chapter 3 addresses a major lacuna in the literature by presenting a novel account of medical treatment. Chapters 4 and 5 present an account of treatment effectiveness: Chapter 4 in the context of the generalizability of clinical trial results and the popular but problematic distinction between explanatory and pragmatic trials, and Chapter 5 regarding how treatment effectiveness is sensitive to non-epistemic considerations, and what this means for EBM+ and a reformulated set of Bradford Hill’s viewpoints that I apply specifically to helping to establish treatment effectiveness. The account of treatment effectiveness I develop in these two chapters sets the stage for Chapter 6, which presents a conceptual framework and clinically relevant model for collaborative, individualized treatment decision-making—a practical application borne from a philosophical approach. In Chapter 7, I further apply philosophy to practical matters in medicine by offering a comprehensive analysis of psychoneuroimmunology (PNI), and specifically that of a PNI-based therapeutic approach called mindfulness, which has been claimed to be effective for various ailments. I assert in this chapter that philosophy has much to offer PNI. Finally, in Chapter 8, I examine potential distorting effects on the evidence base for treatment effectiveness claims due to authors’ conflicts of interest. In what may seem a nonintuitive move (considering the prevailing sentiment among philosophers of medicine), I argue that these concerns may very well be misplaced. Overall, the chapters address fundamental issues in the philosophy of medicine, trying to advance the relevant philosophical debates, and highlighting potential practical implications for medicine and medical communications.

Publication year:2022

Keywords:Doctoral thesis

Accessibility:Open