Abstract
Few would deny that contemporary western medicine is scientific, but what exactly is implied by this claim? Recent work in philosophy of science has brought research on the demarcation problem to bear on this question and has argued that medicine is a science. Authors disagree on what demarcates scientific medicine as a science from pseudosciences like homeopathy, whether it is scientific medicine’s systematicity, its reliance on clinical trials, or something else. However, this framing misses out on the historical dimension of scientific medicine, which was emerging as the dominant medical tradition in the West around the turn of the twentieth century. Not only do several proposed demarcation criteria fail to capture this timing (systematic diagnostic classification came earlier, the boom in clinical trials came later), but they also fail to recognize that scientific medicine in the nineteenth century involved new and more intimate relationships between medicine and independent sciences. Rather than asking what makes contemporary western medicine a science (assuming it is indeed one), in this talk I ask what makes contemporary western medicine ‘scientific medicine’, what demarcates scientific medicine from non-scientific medicine. Probing the latter question reveals that scientific medicine is a shifting model of medicine in history and today. In brief, scientific medicine results from the integration of medical practice with particular medical sciences and it models itself after these sciences in various respects. Different medical sciences have vied for this role. In the late 1800s, laboratory sciences, especially physiology, biochemistry, and bacteriology, characterized scientific medicine, which was taken by experimental physiologist Claude Bernard to mean ‘experimental medicine’. In the late 1900s, epidemiology played a large role in reshaping scientific medicine, which was rebranded as ‘evidence-based medicine’, with ‘evidence’ standing in for epidemiological evidence. Today, molecular genetics and computer/data science promise to remake scientific medicine in their image under the labels of ‘precision medicine’ and ‘deep medicine’, respectively. Whether they succeed will depend on whether precision medicine or deep medicine involve merely using new knowledge and technologies towards pre-existing medical ends, or rather imply a more radical reimagining of core medical concepts and reasoning (e.g. personalized diagnosis and treatment that do away with diagnostic categories and population data, medical AI that replaces much of the cognitive work of the clinician). These historical and potential future shifts in scientific medicine are the source of important new philosophical and practical problems. For instance, the remaking of scientific medicine in the image of epidemiology by the late 1900s brought with it the problems of multifactorial etiology and medical risk through the application of epidemiological methods and concepts to medicine (namely, multivariate statistics and risk-based outcome measures, respectively). These developments are not captured by asking whether medicine is a science. They only come into focus when we recognize that scientific medicine derives its scientific character from other sciences and that over time different sciences – from experimental physiology to epidemiology – have competed to claim the mantle of ‘the science of medicine’.
