I’m speaking at the University of Copenhagen 26 April on this topic.
I’m speaking at the University of Copenhagen 26 April on this topic.
The African Centre for Epistemology and Philosophy of Science (ACEPS) is housed in the Department of Philosophy at the University of Johannesburg. ACEPS fosters intra-African and global conversation in the areas of Epistemology and Philosophy of Science by bringing African insights, questions and values into meaningful conversation with other philosophical traditions. ACEPS was founded in 2016 by co-directors Professor Alex Broadbent and Professor Veli Mitova, and Dr Mongane Wally Serote, Dr Ben Smart, Chad Harris and Zinhle Mncube. ACEPS’s groundbreaking philosophical work is organised around three umbrella projects:
• Indigenous Knowledge Systems;
• Health and Medicine in Africa; and
• Rationality and Power.
Kindly diarise the following date for the Centre’s launch:
• Date: Friday, 19 May 2017
• Time: 15:00-17:30
• Venue: Humanities Common Room, C-Ring 319, Auckland Park Campus, University of Johannesburg
The launch will take the format of a public forum where panelists will exchange their opinion and ideas on the following topic: “Why an African Centre for Epistemology and Philosophy of Science?” A formal invitation will be sent out soon with all the details.
Anyone interested in attending from further afield is welcome to contact me. There will be a larger conference event organised in due course, with more lead time.
Papers from the December 2016 special issue of IJE are now all available online. Several are open access, and I attach these.
Philosophers who want to engage with real life science, on topics relating to causation, epidemiology, and medicine, will find these papers a great resource. So will epidemiologists and other scientists who want or need to reflect on causal inference. Most of the papers are not written by philosophers, and most do not start from standard philosophical starting points. Yet the topics are clearly philosophical. This collection would also form a great starting point for a doctoral research projects in various science-studies disciplines.
Papers 1 and 2 were first available in January. Two letters were written in response (being made available online around April) along with a response and I have included these in the list for completeness. The remaining papers were written during the course of 2016 and are now available. Many of the authors met at a Radcliffe Workshop in Harvard in December 2016. An account of that workshop may be forthcoming at some stage, but equally it may not, since not all of the participants felt that it was necessary to prolong the discussion or to share the outcomes of the workshop more widely. At some point I might simply write up my own account, by way of part-philosophical, part-sociological story.
This is the first time I’ve seen a job with Philosophy of Epidemiology listed as a need in a job advertisement (other than one written by me). It’s a Lectureship in Philosophy in Cork.
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.
Following the initial dinner at the causal inference workshop, it is clear that there are both insights and mistakes flying around. Epidemiologists are way ahead of philosophers in some respects, especially in their appreciation for the varieties of causal situation that can arise, and in their treatment of general causation and especially quantitative treatments of it. On the other hand they make some persistent errors, some of which a philosophical training would prevent, and some arising from the intrinsic difficulty of the subject. The problem, and perhaps the place where philosophical input could be most useful, is that the issues aren’t clearly partitioned, and discussions roam from one point to another, with interlocutors not clearly recognizing the logical links, or lack of them, and thus ultimately not able to separate their errors from their insights. Perhaps what I have just described sounds like many philosophical discussions too, but philosophers do characteristically–to a fault, perhaps–distinguish issues. “Ah, but that’s a different question,” is a common retort.
In the present debate, a framework within which certain issues could be separated from others, some parked and some revved up, would be very helpful. I’m not sure how to achieve it, without a huge synthesic survey of everything that has been written. Perhaps that is the only way.
I suspect that I would not have made it through my PhD without the institution pictured below:
During “Fall” 2006, when I was a Visiting Fellow at the above-pictured bus’s destination, Pinnochio’s was my lunchtime sustenance, the thing I looked forward to all morning as I sat in the library of the Philosophy Department wondering whether the debate between Stalnaker and Lewis on counterfactual excluded middle had any bearing on Schaffer’s contrastivist treatment of causal selection.
But wait: when I say that I would not have got through without Pinnochio’s, what exactly am I envisaging? A situation where Pinnochio’s was there but I never discovered it? A situation where it had never existed? –or where perhaps it closed just as I found it, like my second favourite, Burritos? (I still sometimes wonder what might have been.) Or perhaps a situation where Pinnochio’s existed, but didn’t do such good pizza; pizza such as this:
It is interesting to be back in the same place thinking about the same questions ten years later, and satisfying to have come quite an unpredictable route, both intellectually and geographically. In 2006 I had never heard of epidemiology, much less contemplated working on it; and when I got into epidemiology, I thought I had decided to move away from working on counterfactuals and causation. It is curious how things turn out.
I am here for a Radcliffe Institute workshop mostly centering around an upcoming special issue of the International Journal of Epidemiology on causal inference. Previously I posted links to papers in IJE earlier this year, and the special issue promises to be really interesting–a real resource, for sociologists, philosophers and perhaps historians, as well as for epidemiologists.
On the long journey from Johannesburg to Boston I read or re-read as much as I could of what has been published or written on this during 2015 and 2016. I can see some real progress. It is clear that nobody intends to restrict causal claims to those that can be relativized to a humanly feasible intervention, for example. It is also clear that at least some of the debate concerns matters of presentation. It is important to me, for example, not to be cast as a methodological Luddite who insists on putting verbiage in the way of honest, hardworking methodologists who just want to get on with the job. It is important to those methodologists, on the other hand, not to be cast as any sort of methodological fascist, intent on forcing everyone to employ a preferred set of methods, and excommunicating everyone else.
On the other hand, serious questions remain. From what I have read, the main ones are as follows.
The last question in particular is uncomfortable, since it sounds unpleasantly personal. It really isn’t personal; it is not any sort of attack, and indeed it extends to this very debate, and to myself.
The two churches between my Sheraton and Pinnochio’s have signs outside saying “BLACK LIVES MATTER”. A helpful reminder, since I didn’t see many black people on my walk. Most of those I did see appeared to be homeless, so the signs must be quite affirmative for them. The other diners at Pinnochio’s were all white men: two professors having a long conversation about a running conflict with an absent colleague, and three students probably still in their teens, two of whom were in suit and tie. I think they were choristers. I was feeling right at home, until one of the youngsters said to another, “How many suits do you have?”
After a pause, the other said “Six or seven.” The way he said it I could tell he had at least twelve.
I have three, only one of which both is clean and fits me.
Had I not discovered Pinnochio’s ten years ago, perhaps two of them would fit me.