Making Medical Knowledge

by Miriam Solomon

How is medical knowledge made? New methods for research and clinical care have reshaped the practices of medical knowledge production over the last forty years. Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods. Making Medical Knowledge explores their origins and aims, their epistemic strengths, and their epistemic weaknesses. Miriam Solomon argues that the familiar dichotomy between the art and the science of medicine is not adequate for understanding this plurality of methods. The book begins by tracing the development of medical consensus conferences, from their beginning at the United States' National Institutes of Health in 1977, to their widespread adoption in national and international contexts. It discusses consensus conferences as social epistemic institutions designed to embody democracy and achieve objectivity. Evidence-based medicine, which developed next, ranks expert consensus at
the bottom of the evidence hierarchy, thus challenging the authority of consensus conferences. Evidence-based medicine has transformed both medical research and clinical medicine in many positive ways, but it has also been accused of creating an intellectual hegemony that has marginalized crucial stages of scientific research, particularly scientific discovery. Translational medicine is understood as a response to the shortfalls of both consensus conferences and evidence-based medicine. Narrative medicine is the most prominent recent development in the medical humanities. Its central claim is that attention to narrative is essential for patient care. Solomon argues that the differences between narrative medicine and the other methods have been exaggerated, and offers a pluralistic account of how the all the methods interact and sometimes conflict. The result is both practical and theoretical suggestions for how to improve medical knowledge and understand medical controversies.

Genres: Philosophy

278 pages, Hardcover

First published April 2, 2015

Reviews

[Scott Pearson · Rating 4 out of 5]

Epistemology. It’s a big philosophical word that addresses the basic question, how do you know something? It’s a huge and complex question in the world of medicine. How do you know one way is better than another? It applies to individuals approaching diagnoses and treatment plans; it applies to doctors seeking advice about specific diseases; and it applies to researchers seeking to guide collective judgment about possible outcomes. This book tackles this problem head-on with an eye towards contemporary issues. It accomplishes its intended goal of bringing these issues to light.

First, I must address expectations. This is a philosophical book about the biomedical research literature. It is not written by a practitioner in the medical system or even a biomedical researcher. It is written by a person of letters who studies the healthcare system. The astute reader will notice some practical gaps in the author’s experience. If that fact poses an issue for a certain reader, that reader should not read this book. I am interested in reading all perspectives on healthcare, so this book interests me.

Solomon hits on the right topics – narrative medicine, translational medicine, personalized medicine (though only to a limited extent), evidence-based medicine, and how consensus is reached in medicine. Each chapter operates as its own autonomous unit, meaning that the entire book need not be read in order for a topic to be understood. In my medical training, I thought about these issues but did not have the time to explore them in depth. It’s nice to get a critique by a skilled mind on these issues. Most doctors are familiar with the quandaries presented here. This book provides a “deep dive” into what makes these issues controversial. It does not stake out a position on the controversy but instead portrays a plurality of voices about the issues. As such, Solomon’s voice can raise important issues that healthcare practitioners can benefit from thinking through.

[Gijs Limonard · Rating 5 out of 5]

Excellent work on medical epistemology; only downside; it is not written by someone actually working in medicine/health care so a bit distant and academic at times; on the subject be sure to check out these seminal works; Medical Nihilism, Limits to Medicine: Medical Nemesis: The Expropriation of Health, Intuition in Medicine: A Philosophical Defense of Clinical Reasoning, How Doctors Think: Clinical Judgment and the Practice of Medicine, The Philosophy of Evidence-based Medicine Medical Reasoning: The Nature and Use of Medical Knowledge.