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Broadening the scope of our understanding of mechanisms: lessons from the history of the morning-after pill

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Abstract

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections between mechanistic processes and more fundamental reasons for (or against) medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill (emergency contraception) to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates.

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Notes

  1. I thank an anonymous reviewer for suggesting that socially relevant philosophy is the next step in the philosophy of mechanisms after the turns to history, practice, and the special sciences.

  2. Overlooking some of the differences between their accounts, the specifics range from organized entities and activities that operate regularly and cyclically (Machamer et al. 2000) and complex systems whose parts interact directly and invariantly to make a difference between variables (Glennan 2002) to a structure performing a function by virtue of its organized parts (Bechtel and Abrahamsen 2005). However, for my purpose of understanding the production and use of mechanistic knowledge, these nuanced distinctions are immaterial.

  3. There has been extensive philosophical debate over the sharpness of these context-based distinctions and their epistemic import (see Schickore and Steinle 2006). Nevertheless, if understood as loosely overlapping phases operating throughout inquiry, they provide a useful structure for framing my analysis.

  4. Since I aim to expand and then reframe the discussion, I will not evaluate these existing arguments, although I will note criticisms (see footnotes 5, 7, 8, and 9).

  5. In contrast, Jeremey Howick (2011) argues that mechanistic reasoning is not a reliable heuristic because of its high cost-to-benefit ratio.

  6. Unlike the developers themselves, some of their collaborators and patrons were feminists committed to women’s liberation, such as Margret Sanger and Katharine Dexter McCormick. Nevertheless, they were all motivated to some degree by eugenics and the need for population control (see Marks 2001; Marsh and Ronner 2008).

  7. However, one should note that it not a hierarchy of evidence per se but of methodologies (Bluhm 2005). For a review of critiques of Evidence-Based Medicine, and an analysis of its proper place in medical epistemology, see Solomon (2011, 2015).

  8. This evidential function in the strong form advocated by Russo and Williams is more contested than the heuristic one. Medical researchers (e.g., Guyatt et al. 2015) and institutions (e.g., the Cochrane Collaboration) oppose it implicitly by omission from their hierarchies of evidence. Several philosophers argue against the evidential function of mechanism explicitly (Andersen 2012; Bluhm 2013; Broadbent 2011; Dragulinescu 2012; Solomon 2015), while others argue that the possible evidential import of mechanistic evidence can be outweighed by commercial forces (Holman 2017).

  9. Nonetheless, some philosophers have condemned such attempts to generalize or extrapolate from mechanistic knowledge as dubious because of the instability of mechanisms across populations (Howick 2011; see also La Caze 2011).

  10. While beyond the scope of this paper, I think that such standards are empirically unsatisfiable and thus deceptive.

  11. I thank David Teira and Ashley Graham Kennedy for suggesting this objection and possible responses.

  12. I thank Robyn Bluhm, David Teira, and an anonymous reviewer for pressing me to expound on these epistemic implications of value-ladenness.

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Acknowledgements

I gave an earlier version of this paper at the 2017 International Society for History, Philosophy and Social Studies of Biology in Sao Paulo, Brazil, and received many helpful comments from the audience. Special thanks to Elisabeth Lloyd and Jutta Schickore for advice and support. Additional thanks to Robyn Bluhm, Sandy Gliboff, Kate Grauvogel, Nora Hangel, Bennett Holman, Ashley Graham Kennedy, Naomi Oreskes, Emanuele Ratti, David Teira, and two anonymous reviewers for helpful comments and engaging conversations.

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This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. 1342962. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.

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  1. Department of Communication, Liberal Arts, and Social Sciences, New Mexico Institute of Mining and Technology, Socorro, NM, 87801, USA

    Christopher ChoGlueck

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ChoGlueck, C. Broadening the scope of our understanding of mechanisms: lessons from the history of the morning-after pill. Synthese 198, 2223–2252 (2021). https://doi.org/10.1007/s11229-019-02201-0

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