Unit information: The Philosophy and History of Medicine in 2015/16

Unit name	The Philosophy and History of Medicine
Unit code	PHIL30082
Credit points	20
Level of study	H/6
Teaching block(s)	Teaching Block 1 (weeks 1 - 12)
Unit director	Dr. Grose
Open unit status	Not open
Pre-requisites	None
Co-requisites	None
School/department	Department of Philosophy
Faculty	Faculty of Arts

Description including Unit Aims

The aim of this unit is to introduce some key elements of the philosophy of medicine in their historical context. 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 discredited 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

The Unit is structured around five broad learning themes each of which will be explored using one or more sub-topics or specific case studies. The student completing this unit should be able to demonstrate knowledge and understanding of the following themes  particularly with reference to the cited case studies and examples (which will be drawn upon selectively and augmented by the Unit director).

1. Classical medical thought  how Greek and Roman physicians viewed the medical universe and constructed knowledge about it.

• The Hippocratic tradition

• Galenic medicine in the renaissance

2. The Nineteenth Century  a century of huge change in the institutions and scientific basic of medicine.

• Semmelweis and Lister case studies

• Changing disease concepts and the origins of microbiology

• The emergence of the medical profession and the BMA

3. The epistemology of medical science  how medical knowledge is constructed and validated

• logic and reasoning in medicine

• uses and limits of randomized trials and statistical inference in medicine

• fraud in medical research

4. The mind-body question  the relationship between the mind and bodily health and disease and between mind and the physical brain.

• the nature of consciousness

• the placebo effect

• different models of psychiatric illness

• contested diseases like RSI, CFS

5. Reductionism and holism in medical thought

• homeopathy case study

• insights from complexity theory

Teaching Information

• 1 lecture (1hr) per week for one teaching block

• 1 seminar (1hr) per week for one teaching block

Assessment Information

Formative: one 2500 word essay designed to test the intended learning outcomes.

Summative: one take-home exam designed to test the intended learning outcomes.

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).

Also recommended (and a very good read) but controversial is:

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

The best book on philosophy of medicine is:

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

An interesting, if contentious, introduction to some topics in medical epistemology is:

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).