Revolution and progress in medicine

Abstract

This paper adapts Kuhn’s conceptual framework to developmental episodes in the theory and practice of medicine. Previous attempts to understand the reception of Ignaz Semmelweis’s work on puerperal fever in Kuhnian terms are used as a starting point. The author identifies some limitations of these attempts and proposes a new way of understanding the core Kuhnian notions of “paradigm,” “progress,” and “revolution” in the context of a socially embedded technoscience such as medicine.

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Notes

  1. 1.

    See Section 2 of the Postscript in [4], where Kuhn disambiguates his use of “paradigm” in the original text. He later used the term “disciplinary matrix” as a substitute for the broad sense of paradigm described above.

  2. 2.

    I will suggest later in the paper that what is characteristic of paradigms in medicine is that they need to be conceived of in a way that is even broader than Kuhn’s original conception of a disciplinary matrix. This reflects the fact that there are lots of background commitments relevant to the practical success of medicine that go beyond those commitments underwriting its status as a field of inquiry. Medicine is more than just a science; it is a social practice with a particular practical objective, and this results in additional commitments shared by its practitioners.

  3. 3.

    See my article [6] for an explanation of this term, as well as some examples of controversies of this sort. I have also provided elsewhere [7] a detailed case study, using Kuhnian conceptual apparatus, of one such controversy that arose in contemporary physical organic chemistry.

  4. 4.

    In Gillies’s paper, Henle’s work stands in for the current paradigm of disease causation. See Dana Tulodziecki [8] for more details on this third account of disease causation, which she calls “contingent contagionism.”

  5. 5.

    See also Tulodziecki [8], who offers similar criticisms of Semmelweis’s case.

  6. 6.

    It is also worth pointing out that many of the issues of concern in the contemporary philosophy of medicine can be organized using this framework. Each of the parts of a medical paradigm, in this expanded sense, is the subject of work within the philosophy of medicine. For example, the question of the nature of theories in the biomedical sciences is about the first (the theories of disease) component, that of the appropriate design of RCTs is about the second (the assessment of interventions), and that of conflicts of interest in medical education is about the third (the institutional environment in which medicine occurs). Not surprisingly, though, many important issues come up when philosophers consider how these sorts of commitments interact, and whether they should. For instance, recent work on how to extrapolate controlled trials to target populations using mechanistic reasoning (e.g., [9]) asks how commitments to certain mechanisms of disease causation (component 1) can or should constrain the extrapolation of controlled studies of interventions (component 2) into real world social conditions (component 3).

References

  1. 1.

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Correspondence to William Goodwin.

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Goodwin, W. Revolution and progress in medicine. Theor Med Bioeth 36, 25–39 (2015). https://doi.org/10.1007/s11017-015-9319-7

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Keywords

  • Kuhn
  • Revolution
  • Paradigm
  • Progress
  • Semmelweis
  • Puerperal fever