{"id":36480,"date":"2016-04-08T13:53:48","date_gmt":"2016-04-08T12:53:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36480"},"modified":"2016-04-12T10:31:14","modified_gmt":"2016-04-12T09:31:14","slug":"richard-smith-medicines-need-for-philosophy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/04\/08\/richard-smith-medicines-need-for-philosophy\/","title":{"rendered":"Richard Smith: Medicine\u2019s need for philosophy"},"content":{"rendered":"

\"richard_smith_2014\"<\/a>The commonest undergraduate degree of students entering the medical school at University of California Irvine is philosophy. The medical school, traditionally the richest and most arrogant of university departments, has at UC Irvine reached out to the philosophy department for help. At a conference there last month I met a student who is simultaneously studying medicine and doing a PhD in philosophy. I was there at a meeting on social epistemology, feeling a little out of my depth, but I came away with a conviction that healthcare, which is suffering an existential crisis, badly needs the help of philosophers.<\/p>\n

The questions science cannot answer<\/span><\/p>\n

Philosophy, the philosopher Bertrand Russell argued, can be thought of trying to find answers to those questions that neither theology nor science can answer. There was a time when religion provided an answer to every question\u2014How did the world begin? Why are we here? What is a good life? Is there an afterlife?\u2014but sceptics, and philosophers, began in Ancient Greece to look for their own answers.<\/p>\n

Initially science was a branch of natural philosophy, but with a rush in the Renaissance it developed its own experimental methods. Science cannot, however, answer some of our most important questions, and those of us educated in science have to be wary of thinking it might. Philosophy can\u2019t answer most of them either, but it provides a means of rigorous and critical thinking and examination that can keep us from hubris, something to which medicine is prone.<\/p>\n

What is medicine for?
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\nScience has in the past century given medicine tremendous impetus and capacity, but it can\u2019t answer questions like \u201cWhat is medicine for?\u201d It can\u2019t even define health. Medicine is a discipline and most doctors within it have not stopped to ask \u201cWhat is medicine for?\u201d but have rushed ahead to do whatever it can. As doctors are interested primarily in disease in all its protean and sometimes spectacular forms the business of medicine has become \u201cfighting disease\u201d rather than promoting health, but what are we fighting disease for, and how far should we go? Are we trying to defeat death? Is extending life our aim? Is a longer life a better life? And what is disease anyway? Is the concept of disease still the best way for medicine to think about what it is trying to do when risk factors become \u201cdiseases\u201d and most patients have multiple \u201cdiseases\u201d? What can we learn from reflecting on \u201cdiseases\u201d like drapetomania (the mental illness that led slaves to escape)? And is it right that healthcare is increasingly consuming resources that could be spent on education, housing, social care, the environment, the arts, and much else?<\/p>\n

Beyond ethics to metaphysics and epistemology
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\nEthics is the branch of philosophy that has developed the closest links with medicine, but perhaps we have just as much need for metaphysics<\/a> (\u201cthe branch of philosophy that deals with the first principles of things, including abstract concepts such as being, knowing, substance, cause, identity, time, and space\u201d) and epistemology <\/a>(the theory of knowledge, especially with regard to its methods, validity, and scope. Epistemology is the investigation of what distinguishes justified belief from opinion).<\/p>\n

Social epistemology and medicine
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\nThe conference I attended at UC Irvine was concerned with \u201csocial epistemology<\/a>\u201d and medicine. I had some idea of epistemology (How do we know things?) but was unsure about social epistemology. I looked it up in Wikipedia, itself I thought a fruit of social epistemology. \u201cSocial epistemology refers to a broad set of approaches to the study of knowledge that construes human knowledge as a collective achievement. Another way of characterizing social epistemology is as the study of the social dimensions of knowledge.\u201d<\/p>\n

I worried that I might not have anything useful to contribute, but I read on: \u201cMore practical applications of social epistemology can be found in the areas of library science, academic publishing, guidelines for scientific authorship and collaboration, knowledge policy, and debates over the role over the Internet in knowledge transmission and creation.\u201d So thinking about medical journals, which might be described as knowledge tools for medicine, is relevant, and evidently my book \u201cThe Trouble With Medical Journals<\/a><\/em>\u201d is used by at least one teacher of social epistemology.<\/p>\n

Examples of how social epistemology can help doctors
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