This project is an historical and philosophical inquiry into four methods that are used to produce medical knowledge: consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. The PI argues that the familiar dichotomy between the "art" and the "science" of medicine is not adequate for understanding this plurality of methods, which developed since the 1970s. Recent work in Philosophy of Science and STS (Science and Technology Studies) has changed the understanding of science presupposed in the traditional dichotomy. In particular, there is acknowledgement of the non-formal, historical, political, pragmatic, value-laden, contextual and contingent aspects of science, making the traditional art/science dichotomy less informative. The PI proposes a pluralistic account of methods in medicine, and focuses on how the methods interact with each other, sometimes reinforcing one another and sometimes producing conflict. Four contemporary case studies will be the focus of her research during the award period: advances in the treatment of cystic fibrosis, recommendations for routine mammography screening, evaluation of the effectiveness of antidepressant drugs and treatment of medication adaptation in migraine.
Intellectual Merit One eventual outcome of this research will be a book, Beyond the Art and Science of Medicine, which will use historical and philosophical methods to produce a systematic account of methodological pluralism in medicine. It will yield normative results that are important for philosophy of medicine, philosophy of science, philosophy of technology, STS as a whole, and methodology in medical research. It will examine, critically and contextually, claims that are often made about new methods, such as they will prove transformative to a discipline. The book will show that scientific disagreement is expected and epistemically beneficial, although it can have political costs.
Potential Broader Impacts The resulting book will be aimed at a wide and interdisciplinary audience, including philosophers and historians of science, science studies scholars, medical humanists, medical research and clinical medicine communities. It is also intended that the book and related articles will enrich curricula in philosophy of science (which currently focus on the "pure" sciences of biology and physics) as well as curricula in the medical humanities and in science studies. Its broadest intended impact is on scientific controversies. Current case studies in medicine are selected so that the project is immediately relevant for comprehending and dealing judiciously with controversies in health care.
" was an historical and philosophical investigation of recent new methods in medicine, specifically consensus conferences, evidence-based medicine, translational medicine and narrative medicine. The development of these methods challenges the traditional bifurcation into the "art" and the "science" of medicine; a pluralistic framework replaces it. NSF support was specifically requested for the development of cases of methodological pluralism in medicine. Two such cases (out of four originally proposed) were fully explored in the grant period: the treatment of cystic fibrosis and recommendations for routine mammography screening. These two cases were centrally featured in the book length manuscript, Making Medical Knowledge, which was completed in July 2013 and is currently under review at Oxford University Press (UK). The screening mammography case is also the main example in a chapter "Social Epistemology" for the forthcoming Philosophy of Social Science: An Undergraduate Text, editors Nancy Cartwright and Eleanor Montuschi, to be published by Oxford University Press. This is a broader impact of the project, since the textbook is intended for wide use in both philosophy of science and social science curricula. Another broader impact, from the book Making Medical Knowledge, is the provision of tools for understanding medical controversies. These tools are intended to produce better decision making in healthcare and healthcare policy.
