Why Medicine Needs Philosophy

Philosophy of HealthPractical Insights and Resources

Feb 3

I recently came across a fascinating article published in PNAS in 2019 (https://doi.org/10.1073/pnas.1900357116), where a group of nine well-established philosophers and scientists make a compelling case for the complementarity of the two disciplines by providing interdisciplinary examples in stem-cell research, the study of the microbiome, and cognitive science.

These examples demonstrate how philosophical analysis can sharpen and inform the scientific process and foster innovation.

The authors argue that philosophy enhances the scientific process by challenging assumptions, helping formulate scientific questioning; it offers a broader conceptual and ethical framework and provides critical thinking.

The authors also remind us that the argument for separating science from philosophy has only become more heated since the middle of the 20th century. It is interesting to note how modern scientists who changed our understanding of reality, such as Niels Bohr, Werner Heisenberg, and Albert Einstein, contributed significantly to both scientific progress and philosophical understanding.

It seems strange that science and philosophy are at odds because they both ask the same question: “What is the nature of reality?” Rather, it is the approach to addressing this question that is more controversial.

Philosophy is speculative; it often overcomplicates scientific discussions by introducing untested hypotheses or asking too broad questions and isn’t practical, and therefore science has no time for it.

However, if science did not ask speculative, complex questions of no immediate practical use about the nature of the universe, life, gravity, time, or space; Newton, Einstein, Heisenberg, Darwin, or Hawking would not have a place in history.

The reality is that, whether we like it or not, philosophical thought has been instrumental in guiding and shaping the foundation of science. A science solely focused on empirical and practical applications inevitably stifles innovation and prevents the exploration of new ideas.

I feel that the argument for the separation of science and philosophy is particularly acute in the social sciences and in the biomedical sciences.

Could it be that the frictions between philosophy and these “human sciences” are more strident because, unlike physics and mathematics, they are both somewhat dependent and bound by the philosophical underpinnings related to reductionism and of human exceptionalism central to the Age of Enlightenment, which fathered modern society?

Much of Western science, including medicine, sociology, or psychology, have their roots in ancient Greek philosophy. Plato, Aristotle, and Hippocrates created a common foundation for both philosophy and science, spanning from the physical sciences to the nature of the universe and life. Their thinking remained pretty much unchallenged until the 17th century when the scientific revolution further distanced science from pure philosophy and matured into its present form in the 19th century.

One of the fundamental principles of the scientific revolution was the belief that systematic observation of nature, coupled with empirical experimentation, would provide the answers to our questions about the natural world. This was a significant shift from earlier traditions, which relied mostly on philosophical reasoning, religious doctrine, and ancient texts to explain natural phenomena.

This approach revolutionized fields such as physics, mathematics, ecology, and biology by providing a reliable method for uncovering natural laws and principles. However, the application of the scientific method to human behavior and pathology faced significant challenges. The observation of nature alone could not explain human behavior, pathology, or social norms; factors such as culture and particularly human subjectivity do not seem to follow any natural patterns or ecological structures observed in the non-human world.

While we must acknowledge the deep and complex historical, theological, and philosophical roots of this concept, human exceptionalism in the modern scientific sense is the idea that humans possess unique characteristics such as language, consciousness, self-awareness, culture, and complex social behaviors which distinguish them from other animals, ecological systems, and natural phenomena.

While this idea of human exceptionalism is being confuted by modern research, at the time for branches of sciences such as anthropology, archaeology, psychology, and sociology, the solution was to abandon the reference to the natural world and the physical sciences and instead focus on the direct interpretation of human behavior in isolation, mostly through consensual and self-referential research.

Medicine went in a different direction. The founder of Western medicine, Hippocrates, grounded the science of medicine in the principles of careful observation and empirical reasoning and promoted a naturalistic approach to understanding the cause of illness. Most of the medical progress between the time of Hippocrates and the 17th century, nearly 2000 years later, was mainly in the fields of surgery, anatomy, and physiology, which fostered the notion that the human body is pretty much a machine that only becomes human once a soul inhabits it.

Because of this, it is only natural that with the scientific revolution, medicine naturally aligned with the physical and biological sciences, leaving the uncertainties of human individuality and unpredictability and the complexities of consciousness to concern other disciplines.

While the near totality of scientific investigation in the medical field leading to the major discoveries of the pathophysiology of disease and modern medicine as we know it is as recent as the 19th century, it is unquestionable that such an empirical, objective, evidence-based approach to medicine, supported by biology and technology, has been extremely successful across many areas from infectious disease to oncology, from surgery to pharmaceutical science and diagnostics, leading to a sharp decrease in overall morbidity and mortality and increased health for humanity overall

However, a mechanistic, deterministic and system-specific approach to medicine has led to an increased trend towards protocol-based approaches and medical ultra-specialization which, particularly in the case of multisystemic chronic diseases prevalent in today’s medicine, can cause significant diagnostic and therapeutic delays but also significant problems in managing multidisciplinary care.

Over the last thirty years, starting in 1996, for the first time since the end of the Second World War, life expectancy has been slowly decreasing in the US. And since the middle of the 20th century, we have witnessed a significant rise in morbidity and mortality due to cancer, cardiovascular disease, chronic autoimmune degenerative and inflammatory diseases, as well as a staggering rise in mental health disorders.

A perhaps even greater challenge to conventional medical thought is coming from the science itself.

In a similar way that quantum mechanics challenged and expanded upon classical Newtonian physics, molecular biology is reshaping our fundamental understanding of the life sciences.

Like Newtonian physics, classical biology is based on reductionist principles where a biological system is analyzed by breaking it down into smaller parts and determining a hierarchy within the parts. The fundamental assumption of this method is that the isolated molecules, as well as discrete disease systems and their structures, have sufficient explanatory power to provide an understanding of the whole process.

However, recent advances in molecular biology reveal the complex, networked interactions within biological systems and between genetic, epigenetic, and environmental factors. In the same way that quantum mechanics has revealed a level of interplay in the physical world that was previously unimagined, where the behavior of molecules is interdependent and non-linear, molecular biology reveals similar complexity and interdependence at the molecular and cellular levels, showing how diverse biological pathways and networks interact dynamically, challenging the traditional hierarchical view of biological processes and their independence from any external factors.

The intersection of the new scientific challenges medicine is facing and events such as the opioid crisis and the Covid pandemic more recently, have resulted in a sharp loss of trust and confidence in the medical and healthcare systems which are increasingly seen by the general public as inefficient, detached, de-humanized, self-serving, and driven only by financial interest

This is why medicine needs philosophy.
Just as the early 20th-century philosophical revolution catalyzed a seismic shift in physics, the biomedical sciences now stand on the cusp of a similar transformative moment. The past century's linear, reductionist approach is increasingly inadequate in the face of the intricate complexity of human biology. The fields of genomics, proteomics, and metabolomics have unveiled a vast and dynamic network of interconnections within the human body, challenging the conventional 'one gene, one disease' paradigm

Moreover, the growing understanding of the microbiome, epigenetics, and the psychosocial determinants of health underscores the limitations of a purely mechanistic view of health and disease.

Just as quantum mechanics and relativity theory demanded a new philosophical framework in physics, these emerging insights in biomedical sciences call for a renewed philosophical perspective that embraces complexity, systems thinking, and a more integrative approach to understanding human health.

This paradigm shift would not only revolutionize our approach to disease diagnosis and treatment but also necessitate a reevaluation of our ethical, legal, and social frameworks in healthcare. Embracing this philosophical transformation is crucial for the biomedical sciences to advance in a manner that is holistic, patient-centered, and attuned to the multifaceted nature of human health and disease.

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