Unit information: The Philosophy and History of Medicine in 2016/17

Unit name	The Philosophy and History of Medicine
Unit code	PHILM0022
Credit points	20
Level of study	M/7
Teaching block(s)	Teaching Block 1 (weeks 1 - 12)
Unit director	Professor. Bird
Open unit status	Not open
Pre-requisites	None
Co-requisites	None
School/department	Department of Philosophy
Faculty	Faculty of Arts

Description including Unit Aims

This unit concerns some of the key elements of the philosophy of medicine in their historical context. It focuses particularly on the philosophy of medicine in through the ages: Greek medical thinking, Galenic theories of the Renaissance, the upheavals of the 19th Century; and contemporary debate on holism and reductionism. Additionally it looks, at the putative relationships of soul, mind, emotion, brain and illness. Given the scope of this field, teaching will largely be through specific case studies and topics, such as the Hippocratic Oath, the "Four Elements", the emergence of the medical profession in the 19th Century, medical logic, the limits of statisitical inference and the insights of complexity theory. There will be a lecture and a seminar in each of the twelve weeks of the teaching block.

This unit aims to give students an understanding of:

• How medical knowledge has developed in the last 200 years.
• How to think critically about current medical practices.

Unit objectives:

If you get ill, you are very lucky you live now rather than 200 years ago, when simple infections would often prove fatal, surgery was carried out without pain relief, and almost all illnesses were treated with blood letting and medicines based on the poisons mercury and antimony. It might appear that current medicine magnificently demonstrates the triumph of applied science. But the truth of this claim is in fact far from obvious. This unit examines some of the philosophical questions arising from the history of the making of modern medicine, from the new hospitals of the French Revolution, through the so-called laboratory revolution of the late-nineteenth century and the golden era of twentieth century medicine to the AIDS pandemic and the growth of the alternative medicine movement. Questions addressed include:

• What is disease? And what is health? Are these biological concepts? Or do they have a subjective or a social component?
• How did the introduction of mass hospitals in the late eighteenth century transform the relationship between doctor and patient, and with what result on the doctor’s means of diagnosis on the one hand and opportunities for expanding medical knowledge on the other? (We look here at Michel Foucault’s notion of ‘the clinical gaze’.)
• Did medical science lead directly to improvements in medical care? Or were the two unrelated until the late nineteenth century before which time doctors did more harm than good?
• Was there a laboratory revolution in nineteenth century medicine? What difference did the microbiological discoveries of Pasteur, Koch, and others really make to medicine?
• How can generic medical knowledge produced by randomised controlled trials be applied to the diagnosis and treatment of individuals? Does ‘evidence-based medicine’ enable scientific advances to extend to the GP’s surgery? Or does it allow a flawed methodology to trump the skill and experience of doctors in understanding individual patients?
• Do complementary and alternative medical practices encapsulate different modes of medical knowledge from scientific medicine? Or are they at best expensive placebos and at worst dangerous and discredit quack remedies?
• We are often told that studies show that environmental factor X causes disease Y, and then are told that this is contradicted by other studies. How do we determine causation in epidemiology?

Intended Learning Outcomes

On successful completion of this unit, students should:

1. Have acquired knowledge and understanding of various key issues in central areas in the philosophy and history of medicine,
2. Be able to construct and analyze sophisticated philosophical arguments and engage with other philosophers in constructive debate. Be able to communicate ideas clearly and effectively to an audience, using blackboard, handouts, data projection (e.g. PowerPoint).

Teaching Information

1-hour lecture + 1-hour seminar each week + essay tutorials

Assessment Information

One essay of 5,000-6,000 words (excluding notes and bibliography)

Reading and References

The following books are strongly recommended background reading to the history of medicine and the historiography of medicine: ASS= Arts and Social Science Library. MED= Medical Library (down University Walk)

• Porter, R. (1999) The Greatest Benefit to Mankind (Fontana) (ISBN: 0006374549). ASS (R131 POR), MED

Burnham, J. C. (2005) What is Medical History? (Cambridge: Polity) (978-0745632254).

• Harry Collins and Trevor Pinch (2005) Dr. Golem: How to Think about Medicine (London: University of Chicago Press). A useful introduction to key themes in the epistemology of medicine. (ISBN: 0226113663) ASS (RC81 COL ) MED (AA8a COL).

Also recommended but controversial are:

• David Wootton (2007) Bad Medicine: Doctors Doing Harm Since Hippocrates (Oxford: Oxford University Press)

• Harry Collins and Trevor Pinch (2005) Dr. Golem: How to Think about Medicine (London: University of Chicago Press). A useful introduction to key themes in the epistemology of medicine. (ISBN: 0226113663) ASS (RC81 COL ) MED (AA8a COL).

The best recent book on philosophy of medicine is:

• Jeremy Howick (2011) The Philosophy of Evidence-Based Medicine (Oxford: Wiley–Blackwell)

Some other recommended books on the history of medicine are:

• John Pickstone, Ways of Knowing: A new history of science, medicine, technology and medicine, Manchester: Manchester University Press, 2000. (ISBN:0 7190 5994 1) MED.
• W. F. Bynum, Science and the Practice of Medicine in the Nineteenth Century, Cambridge: Cambridge University Press, 1994. Definitive historical synthesis of the social and epistemological changes in medicine that gave rise to scientific medicine in the nineteenth century. (ISBN-13: 9780521272056 | ISBN-10: 052127205X) ASS (R149 BYN), MED.
• Andrew Cunningham, The Making of Modern Medicine, (Radio 4 Series), London: BBC Audiobooks, 2007. MED (ISSUE Desk AA3CUN) (Alexander Bird has these CDs also, so ask him if you want to borrow them.)

Online resources

Medical Humanities: New York University’s Literature, Arts, and Medicine Database http://litmed.med.nyu.edu/Main?action=new eJournals: Medical Humanities; Journal of Medical Humanities

History of Medicine: eJournals (available through UoB information services): Medical History; Social History of Medicine; Journal of the History of Medicine and Allied Sciences; Studies in History and Philosophy of Biological and Biomedical Sciences

UoB Medical Library: http://www.bris.ac.uk/is/library/subjects/medfac/info/internetlinks.html

Wellcome Library: http://library.wellcome.ac.uk

Wellcome Medical Photographical Library: https://wellcomeimages.org

History of the Health Sciences World Wide Web Links: http://www.mla-hhss.org/histlink.htm

National Library of Medicine (US): http://www.nlm.nih.gov

MedHist: http://www.intute.ac.uk/healthandlifesciences/medhist

Philosophy of Medicine eJournals: Journal of Medicine and Philosophy; Theoretical Medicine and Bioethics; Medicine, Healthcare and Philosophy; Philosophy, Ethics and Humanities in Medicine