About Alex Broadbent

Professor of Philosophy, University of Johannesburg

Synopsis of my book

Further to previous post, here is a synopsis of the book, with a slightly different structure from the previous ToC, but largely the same. I am considering removing the first chapter, “What Is Philosophy of Medicine?”, on account of it being a bit boring for non-philosophers. I can do what I need to by way of setting up methodologies in the introductory material.

Any thoughts on whether the book described below fits the title “Philosophy of Medicine”, or something else (“Medical Cosmpolitanism”?), would be appreciated.

Synopsis

The book sets out to answer two questions: “What is medicine?” and “What attitude should we adopt towards it?” The answer to the first question informs the answer to the second. Through answering these two questions, the book provides a unifying vision of the field that is at once useful for someone looking for a way into the field and novel enough to interest the expert.

Chapter 1, The Variety of Medicine, surveys historical and contemporary medicine in various locations around the world, emphasizing the differences between traditions and the extent to which traditions change. This enormous variety means that an empirical survey alone is not enough to tell us what medicine is.

Chapter 2, What Is Medicine?, sets out two broad answers to the title question. The first is the Curative Thesis, which says that medicine is fundamentally the sustained and organized effort to heal the sick and promote health, without specifying anything about the means employed, and thus about the character of medical activity. The second is the Inquiry Thesis, which agrees that medicine’s goal is healing the sick, but says that its core business understanding and predicting health and disease. Cure is a central goal on both views. The main difference between them is that on the Inquiry Thesis, medicine can partially succeed even when it cannot cure, while according to the Curative Thesis, curative failure is complete failure for medicine.

Chapter 3, What Are Doctors Good At?, argues against the Curative Thesis and in favour of the Inquiry Thesis, to the effect that medicine is not generally very impressive at curing, but that it has much more success at the core business of understanding and predicting health and disease. If a doctor fails to cure you, you do not necessarily blame the doctor; you may blame the disease. However, if a doctor clearly does not understand what is going on, you will no longer regard them as an expert in the relevant medical field.

Chapter 4, Evidence-Based Medicine, argues that EBM arises from a commitment to the Curative Thesis, elevating effectiveness of interventions as the sole measure of medical success. The chapter argues that this approach to medicine is both unworkable and unwarranted. Much of the warrant for medical interventions arises from theoretical knowledge and not from direct clinical testing. This is both inescapable in practice and defensible in theory.

Chapter 5, Person and Medicine, considers the suggestion that has re-emerged recently in reaction to EBM that Mainstream Medicine is too general, and that the “person” or “patient” needs to be more central. The suggestion does not yield any obvious solutions to the puzzle of ineffective medicine—it does not promise to make medicine strikingly more effective.

Chapter 6, Medical Nihilism, considers the position that takes the bull by the horns, and concludes from the puzzle of ineffective medicine that we should generally have low confidence in any given medical intervention. Nihilism is rejected in this chapter on the grounds that only Therapeutic Nihilism is warranted by this argument, and only an endorsement of the Curative Thesis could support the identification of Therapeutic Nihilism with Medical Nihilism. Once this distinction is made, Therapeutic Nihilism can also be rejected, since (like EBM) it ignores much of the important warrant for medical interventions, which lies in the theoretical knowledge underpinning them and not in the results of testing.

Chapter 7, Alternatives and Medical Dissidence, considers the phenomenon of alternative medicine, which is characterized by the explicit rejection of parts or the whole a Mainstream tradition in favour of something else, or, alternatively, the belief that Mainstream Medicine leaves something out and can be “complemented” by other practices. The chapter argues that the enormous reliance on expert testimony in any medical encounter precludes the excessively strong moral and intellectual judgements that are sometimes made of both patients and practitioners. Further, the chapter argues that part of the motivation for seeking alternative medicine is to find answers to questions that are not answerable within the Mainstream tradition. This is discordant with the Curative Thesis, and fits with the idea that medicine provides more than just cures: it is also expected to yield understanding.

Chapter 8, Decolonizing Medicine, considers the relation between different medical traditions in parts of the world where contemporary Mainstream Medicine is part of a colonial heritage. The chapter argues that it is even less acceptable in this situation to visit very general harsh judgements on practitioners and patients of non-Mainstream traditions. However, the chapter argues that relativism about medicine is fundamentally implausible, because the suffering of sickness is a universal human experience. The notion of Medical Cosmopolitanism is introduced, as an epistemic attitude that is humble and respectful, but not pluralistic, and thus which seeks to enter into conversation and resolve differences rather than simple permit them to continue. The conclusion, ironically, is that medical traditions will tend to merge, and so “medically decolonizing” a region is neither desirable nor likely; but that for this to happen fruitfully and fairly, the cosmopolitan attitude must be adopted, with a view to humbly but critically assessing and resolving differences.

Chapter 9, Health and Disease, considers the subject matter of medicine, which must also be understood if we are to understand the nature of medicine and arrive at a reasonable attitude towards it. Health is identified as a secondary property, which is a property that exists neither wholly independent of being perceived, nor depends wholly on being perceived. The classic example is colour, which depends both on things that do not depend on us at all (such as light of certain wavelenghts striking the eye) and on our dispositions to react in certain ways to these independent events (such as the construction of our eyes and visual systems). Health is a dispositional property depending on the way we react to certain biological states, and the particular content that the health concept has is explained by the evolutionary advantage that having this concept confers. Particular diseases are departures from health for which some general explanation can be found. These notions are compatible with cultural variation in what counts as healthy and diseased (unlike the “naturalist” accounts) but anticipate much overlap, and explain why diseases are usually considered misfortunes (unlike “normativist” accounts).

Chapter 10, Medical Cosmopolitanism, puts it all together. It argues that medicine is best understood as an inquiry with a purpose (as the Inquiry Thesis has it) rather than as the mere pursuit of a goal by whatever means (as the Curative Thesis has it). It argues that this best explains the puzzle of ineffective medicine. It further argues that the status of medicine as an inquiry justifies a cosmopolitan attitude towards it. The value of a medical tradition does not lie solely in its curative success, so it neither wise not just to simply write of curatively unsuccessful traditions.

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What should I call my book?

I’m spending July finalising my manuscript for a book that was to be called Philosophy of Medicine which is under contract with Oxford University Press. However, Routledge has this year published Philosophy of Medicine: An Introduction by the excellent Thompson and Upshur. Do I change my title, or not?

The contents are quite different as you can see by comparing the ToC of that book and the (latest) ToC of my own, below (on which comments are very welcome of course).

My book ends up defending a position that I call Medical Cosmopolitanism, and I could use this as the title, perhaps with a subtitle like “What is medicine and what should we think of it?” or something. But I worry that Medical Cosmopolitanism is going to be confusing.

Any thoughts and ideas are welcome!

My latest ToC:

About this Book

Introduction

Ch 1: What Is Philosophy of Medicine?

Ch 2: Medical Traditions

Ch 3: The Point of Medicine

Ch 4: What Are Doctors Good At?

Ch 5: Evidence-Based Medicine

Ch 6: Person and Medicine

Ch 7: Medical Nihilism

Ch 8: Alternatives and Medical Dissidence

Ch 9: Decolonizing Medicine

Ch 10: Health and Disease

Ch 11: Medical Cosmopolitanism

Call for Papers: Philosophy of Epidemiology, a Special Issue of Synthese

 

Guest Editors: Sean A. Valles (Michigan State University, USA) and Jonathan Kaplan (Oregon State University, USA)

Special Issue Description: Philosophy of epidemiology is a burgeoning subfield within the philosophy of science and medicine. This special issue will provide philosophy of epidemiology with a forum to develop this area and expand its boundaries. The guest editors seek both to help develop philosophy of epidemiology’s existing lines of research (e.g., models of causal analysis) and expand philosophy of epidemiology to include a broader community of contributors (e.g., philosophers of race) and a wider array of lines of research (e.g., concepts of epidemiological risk and human-ecosystem dynamics).

Appropriate topics for submission include, but are not limited to: the role(s) of values in epidemiology; the role(s) of formal models in epidemiology; concepts of risk in epidemiology; the relationship between philosophy of epidemiology and philosophy of ecology (and other branches of philosophy); the metaphysical and causal repercussions of epidemiological data on the environmental and social determinants of health.

For further information, please contact the guest editors:

  • valles@msu.edu
  • kaplanj@oregonstate.edu

Deadline for submissions is: October 9, 2017

DEADLINE 5 MAY: UJ Post doctoral fellow in IKS // African Centre for Epistemology and Philosophy of Science

You may have seen our recent announcement of the launch of the UJ African Centre for Epistemology and Philosophy of Science (ACEPS). UJ has some funding for postdoctoral research fellows and we at ACEPS would like to put forward a strong candidate with specialism in Indigenous Knowledge Systems (IKS). The candidate would be attached to ACEPS and would work alongside Professor Mongane Serote to develop our project and networks in IKS.

PLEASE NOTE THE VERY SHORT DEADLINE, and send materials to Prof Veli Mitova vmitova@uj.ac.za by the end of 4 May in order for us to write a letter of support in time for the final 5 May deadline. Note that anyone is allowed to apply directly to UJ for one of these postdoctoral awards, and ACEPS wishes to endorse at least one application with IKS specialism. ACEPS reserves the right not to endorse an application.

UJ_GES_PDRF_ApplicationForm2017UJ_Postgrad_ResearchFellowsGES_2016_AD_A4

UJ_GES_PDRF_ApplicationForm2017

African Centre for Epistemology and Philosophy of Science (ACEPS): launch announced

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.

Website: https://www.uj.ac.za/faculties/humanities/aceps/Pages/default.aspx

Causal Inference: IJE Special Issue

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.

  1. Causality and causal inference in epidemiology: the need for  a pluralistic approach‘ Jan P Vandenbroucke, Alex Broadbent and Neil Pearce. doi: 10.1093/ije/dyv341
  2. ‘The tale wagged by the DAG: broadening the scope of causal inference and explanation for epidemiology.’ Nancy Krieger and George Davey-Smith. doi: 10.1093/ije/dyw114
    1. Letter: Tyler J. VanderWeele, Miguel A. Hernán, Eric J. Tchetgen Tchetgen, and James M. Robins. Letter to the Editor. Re: Causality and causal inference in epidemiology: the need for a pluralistic approach.
    2. Letter: Arnaud Chiolero. Letter to the Editor. Counterfactual and interventionist approach to cure risk factor epidemiology.
    3. Letter: Broadbent, A., Pearce, N., and Vandenbroucke, J. Authors’ Reply to: VanderWeele et al., Chiolero, and Schooling et al.
  3. ‘Causal inference in epidemiology: potential outcomes, pluralism and peer review.’ Douglas L Weed. doi: 10.1093/ije/dyw229
  4. ‘On Causes, Causal Inference, and Potential Outcomes.’ Tyler VanderWeele. doi: 10.1093/ije/dyw230
  5. ‘Counterfactual causation and streetlamps: what is to be done?’ James M Robins and Michael B Weissman. doi: 10.1093/ije/dyw231
  6. ‘DAGs and the restricted potential outcomes approach are tools, not theories of causation.’ Tony Blakely, John Lynch and Rebecca Bentley. doi: 10.1093/ije/dyw228
  7. ‘The formal approach to quantitative causal inference in epidemiology: misguided or misrepresented?’ Rhian M Daniel, Bianca L De Stavola and Stijn Vansteelandt. doi: 10.1093/ije/dyw227
  8. Formalism or pluralism? A reply to commentaries on ‘Causality and causal inference in epidemiology.’ Alex Broadbent, Jan P Vandenbroucke and Neil Pearce. doi: 10.1093/ije/dyw298
  9. ‘FACEing reality: productive tensions between our epidemiological questions, methods and mission.’ Nancy Krieger and George Davey-Smith. doi: 10.1093/ije/dyw330