Philosophy of medicine: between clinical trials and mechanisms

Abstract

Philosophy of medicine is an emerging and rapidly expanding area in philosophy. Traditionally, philosophy of medicine has been associated with ethical issues arising in biomedical research or medical practice. For instance, ‘traditional’ philosophy of medicine addresses the issue of whether it is ethical or not to conduct research on stem cells, whether we should accept euthanasia or whether it is ethical to deliver web-based diagnoses online to patients. In the last few years, however, scholars in both biomedicine and in philosophy started paying attention to the epistemological and methodological aspects of medicine. For instance, they address the issue of what notion of cause is applicable in biomedical contexts, or what procedures grant extrapolations from animal models to humans. These discussions are carried out in a highly interdisciplinary spirit. Evidence-based medicine (EBM) is an emerging area within medicine. Its main objective is to raise medicine to the realm of objective science by introducing strict standards in research. The standardisation promoted by, e.g., the Cochrane Collaboration is indeed an immense achievement for medicine. By and large, standards for medicines are provided by statistics, more precisely by randomised controlled trials (RCTs). If sound conclusions can be attained in medicine, then it will be thanks to the strict precepts of the ‘evidence hierarchy’, which puts RCTs at the top of the pyramid and expert knowledge at the very bottom. Needless to say, EBM, in order to do that, needs strong philosophical foundations, notably concerning the concept of evidence and the use and role of statistics. Evidencebased medicine has been increasingly attracting philosophers, and this for good reason. Philosophy of evidence-based medicine stands exactly at the crossroad of general philosophy of science, philosophy of causality and philosophy of statistics. Given the growing interest of philosophers and scientists into EBM, Howick’s book is certainly timely. Moreover, no book addressing the whole range of