Exploring Epistemic Humility and its Limits in Therapeutics

Abstract

Exploring Epistemic Humility and its Limits in Therapeutics Douglas Porter, MD* (bio) I would like to thank Scott Waterman for sharing what must have been very challenging personal circumstances. Waterman's reflections touched upon many complex issues. For my part, I would like to explore how Waterman's experience underscores the importance of epistemic humility regarding the limits of scientific knowledge and our sense of the meaning of scientific knowledge while still recognizing the significance and power of scientific knowledge. The first epistemic challenge presented by Scott Waterman's experience of "patienthood" that demonstrates the limits of scientific knowledge is the ability to know pain. Of course, we have all known pain, but such firstperson knowledge would not qualify as scientific knowledge. To scientifically know pain, we would need to have an intersubjectively verifiable correlate of the pain. This is all well and good so long as scientific knowledge is not embraced with a form of epistemic hubris such that scientific knowledge is regarded as the only true form of knowledge. It is not uncommon for the knowledge associated with first-person experience to be denigrated as inherently dubious and merely subjective. Phenomenologists (see Merleau-Ponty, 1964, for example) have pointed out that ultimately the veracity of scientific knowledge must rely upon the veracity of knowledge gained from lived experience and, consequently, regarding first-person experience as inherently invalid is tantamount to regarding the entire scientific enterprise as invalid. Epistemic hubris regarding scientific knowledge may therefore be regarded as self-contradictory and irrational. But, when epistemic hubris regarding scientific knowledge becomes wed, as it sometimes does, to a certain form of metaphysical thinking then epistemic hubris becomes downright pernicious. The metaphysics I am referring to would regard reality as that which is scientifically knowable and, ipso facto, that which cannot be known scientifically as not really real. Such thinking would regard the experience of pain as merely an epiphenomenon to what is really going on which is, loosely put, some nerve signals firing away. Such thinking leads to a perverse inversion of priorities in therapeutics where the person experiencing pain should be understood as the salient phenomenon and the value of scientific knowledge must ultimately be measured by its relevance for addressing that experience of pain. In this sense I can echo Scott Waterman's assertion that humanism and the concern for scientific rigor should not be regarded [End Page 111] as antithetical or even complementary, but are better regarded as being cut from the same cloth. It is the humanist knowledge of the significance and meaning of suffering, in this case the distress of experiencing chronic pain, that motivates and measures the concern for the tools of science to intervene and relieve that suffering. Science untied to humanist moorings in therapeutics is science gone rogue. Waterman's experience with chronic pain demonstrated the need for epistemic humility regarding the limits of scientific knowledge. I think it also underscores the need for humility involving our sense of the exact meaning of science. A friend of mine who happens to be an anthropologist recently attended a party with members of the physics department and found the status of anthropology as a "science" to be met with some incredulity by some of the physicists in attendance. It seems to me that hubris regarding physics being the paradigmatic science would severely hamper any meaningful scientific assessment of the treatment of pain. Waterman explored the scientific relevance of the purported mechanisms of action for several treatment alternatives for pain. The etymology of the term mechanism refers to machines. As I have never known a machine to experience pain, I immediately questioned the limits of mechanistic thinking regarding this topic. But what has been dubbed "the new philosophy of mechanics" (Craver & Tabery, 2019) has jettisoned some of the cartesian physicalist assumptions originally associated with mechanistic reasoning in science. This new philosophy has embraced a more liberal stance to accommodate the myriad ways in which explanatory mechanisms are actually used in scientific practice. As an example, Illari and Williamson (2012) offered this definition of a mechanism for science, "A mechanism for a phenomenon consists of entities and activities organized in such a way that they are...