Ronald Munson, in his essay “Why Medicine is not a Science,” argues that although medicine may be scientific it is not a science. He provides three main arguments to support his claim and it these arguments that I will focus on primarily to assess whether his claim is successful. I will also supplement his third argument which surrounds the reducibility of medicine to science with arguments from Kenneth Schaffner who provides a slightly different argument to Munson. Ultimately I will attempt to show that Munson’s claim is partially successful in that medicine cannot currently be classed as a science but that his claim that it can never be a science is not necessarily the case.
Forstram’s argument
In the first part of his essay, Munson refutes a claim made by L.A. Forstram that medicine is already a science. Forstram, drawing on R.B. Braithwaite says that a discipline is a science if it satisfies two criteria. It must have a “natural domain” and an “investigative function” which commits it to seeking generalisations and to increasing knowledge of phenomena in the domain. Clinical medicine, says Forstram, satisfies both of these criteria. Munson rejects both of these claims. Forstram limits the domain of clinical medicine to “having to do with the natural history of human diseases and the factors affecting these, including the various forms of medical intervention”. Munson says Forstram has “failed to pick out a unique area as the ‘natural domain’ of clinical medicine”. He gives the examples of epidemiology, bacteriology, social work as disciplines that are also concerned with the “natural history of human diseases and the factors affecting them”. With regards to the second criterion Munson says that Forstram makes a means-end confusion. Forstram suggests that knowledge is the primary aim of medicine and therefore satisfies the second criterion. However, Munson argues that medicine seeks knowledge as a means of performing more effectively its task of dealing with disease but that its main and distinctive aim is its social function. In this sense, Forstram is confusing the means of medicine (i.e. the acquisition of knowledge) with its aim i.e. the promotion of health and prevention of disease.
So Munson clearly rejects what he considers the best attempt so far to classify medicine as a science and I agree that he is correct to do so. The scope of Forstram’s criteria is too broad and could allow for disciplines such as a cooking, knitting etc. to be considered “sciences”. This does not seem acceptable and so not only does medicine not fit his own criteria, but his criteria should not be considered sufficient for classifying a science. As such, we should reject Forstram’s claim that medicine is already a science.
Critical differences between medicine and science
In the second part of his essay Munson continues to defend his claim that medicine cannot be classed as a science by comparing three defining aspects of the classical sciences i.e. physics, chemistry, biology with medicine and showing that they are inherently different. Rather than attempt to define what science is and then show that medicine falls outside that definition, Munson looks at the aims, the criteria of success and the internal principles of both science and medicine to show that they do not concur. As such, medicine cannot be classed a science. We will look at these three comparisons now.
The first comparison is the aims. Munson draws the distinction between internal and external aims. The basic internal aim of science is the ‘acquisition of knowledge and understanding of the world and the things that are in it’. There may be external aims for individual scientists or institutions such as the personal gain of research funding or perhaps even a political aim but these are not definitive aims of all science. By contrast, the basic internal and external aim of medicine is to “promote the health of people through the prevention or treatment of disease”. Since the internal and external aims are the same it can be considered an inherent part of medicine. This will be important later when discussing the issue of reduction. The second comparison is of the criteria of success by which we judge both science and medicine. Truth is the criterion of scientific success whereas the basic standard of evaluation in medicine is instrumental or practical success. Munson says this:
“In seeking knowledge, science can be described as a quest for truth about the world. In seeking to promote health, medicine can be described as a quest for control over factors affecting health. Knowledge or understanding of biological processes is important to medicine, because it leads to control. But where understanding is lacking, medicine will seek control in other ways.”
Medical research may have some element of a quest for truth but the underlying principle will always be connected to whether the research will ultimately promote health or prevent disease. Truth will always play second fiddle to the more crucial and practical success of controlling disease.
The third aspect that Munson says significantly differentiates between science and medicine is their respective internal principles and specifically the moral dimension of medicine. Although both disciplines require honesty in reporting scientific results, medicine has a moral dimension that science does not due to the nature of practical medicine. Munson says “a physician, acting in his or her capacity as a physician is committed to promoting the health of any individual accepted as a patient”. Medical practice has an inherently moral aspect. Science is goal-directed, but its end is theoretical, not practical, and science is not committed to promoting any interest at all. By contrast, a physician should have the interest of her patient at heart and not doing so would perhaps be considered “bad medicine”. It is these sorts of value statements which cannot be applied to science. Munson puts it like this:
“The relationship between a scientist and a subject involves attempting to learn something for its own sake, not attempting to do something for the subject’s sake. The case is quite otherwise in medicine and it is through medicines aim and the principle implicit in the physician-patient relationship that medicine acquires a moral character not found in science.”
So what have we established? At the very least Munson has shown that important differences exist between the traditional sciences and medicine. However, can these difference be considered enough evidence that medicine is not a science? In his paper “Philosophy of Medicine,” Kenneth Schaffner says that “apparent differences between sciences cannot be taken as compelling evidence that a reduction cannot be accomplished between those sciences”. So I shall now turn to the question of whether medicine can now or ever will be reduced to a science. If the answer is yes then Munson’s “apparent differences” as well as his claim that medicine is not a science is wrong. Both Munson and Schaffner deal with the issue of reduction of medicine and I shall draw from both their works. Ultimately I shall argue that although there is evidence to suggest that it may one day possible to reduce medicine to a science, we are not there yet.
The reduction of medicine to science
Reduction is the process by which one object, property, concept, theory, etc., is shown to be entirely dispensable in favour of another. In science it is generally accepted that biology can be reduced to chemistry and chemistry can in turn be reduced to physics. There are some who claim that psychology and sociology can be reduced to biology but this is a lot more contentious and raises issues similar to the ones encountered in attempting to reduce medicine to biology. If it is possible to reduce medicine to biology or some accepted science then it would acceptable to say that medicine is also a science. Our aim then, is to establish whether this reduction is possible or not, now or in the future.
Munson’s position is clear. He says that although the content of medicine might someday be reducible to biology, it would be “inappropriate to talk about reducing medicine to biology”. He gives the analogy of hopscotch to explain his reasoning.
“It is inappropriate in the same way it would be talk about reducing hopscotch to physics. As a game, hopscotch must be understood in terms of rules and aims. The pattern of activity displayed in playing the game gains its significance from a network of social convention”.
We recall Munson’s earlier claim that one of the inherent differences between medicine and science is that medicine, unlike science, has a social function that cannot be displaced from it. Both the aims and principles of medicine require the promotion of health and the prevention of disease. Practically this involves treating patients which would include social conventions and some sort of physician-patient relationship. It is this aspect of medicine that Munson argues is not reducible to any science and since it is an inherent part of medicine, the whole of the discipline cannot be reduced either. The question we must ask then is whether or not these social functions are reducible or not?
Other models of medicine have been put forward by philosophers and scientists. Virchow suggested that medicine should be conceived of as a “social science” and George Engel put forward his biopsychosocial model of medicine. (Schaffner) Engel said that too often, physicians have a biomedical vision of medicine in which the “patient is ‘nothing but’ a bag of chemicals”. Like Munson, Engel argues that medicine has a social function which is crucial to medical success. He gives the example of a heart-attack patient who suffers acute stress when being treated by a trainee nurse which eventually gives him a second heart attack. Engel’s suggestion is that better health care would be delivered by physicians mindful of the psychosocial as well as the biological dimensions of illness. Can this biopsychosocial model of medicine be reduced to biology? Schaffner examines this question and suggests that it might indeed be possible.
He gives the example of short-term and long-term learning in Aplysia (a type of marine mollusc). He claims that studies on this creature have provided important results in the area of reduction in neurobiology, namely that there is some social behaviour in Aplysia that can be reduced to a biological process. If this is the case, even on a relatively simple animal, perhaps it is possible in more complex minds such as humans. Schaffner says, “over the past half-dozen years, a number of biomedical scientists have discovered that important connections exist between the nervous system and the immune system in both animals and in humans”. Research into this neuro-immune-endocrine connection has shown that chemical activity in some cancer patients can be directly explained by events such as lack of social support from a spouse or a patient’s poor adjustment. All of this, says Schaffner, provides evidence that a model such as Engel’s biopsychosocial model and Munsons’ social aspect of medicine could in fact be reducible to a science. Therefore, not only would the content of medicine be reducible, but the social function could be too. This is clearly an area in which more research is needed. Philosophically nothing can be concluded since it depends on scientific success but it seems Schaffner has provided enough evidence to suggest that Munson’s view that medicine can never be reduced to a science because of its social function might not be correct.
Munson’s final defence comes from his third comparison of internal principles and the ethical dimension of medicine. The nature of medicine requires us to provide some normative principles which enable us to make decisions in moral situations. For example, what kind of medical research should receive the most amount of funding or when is it moral for a doctor to assist a patient suicide. Can these normative principles ever be reduced to the biological sciences? Schaffner says no and cites the “naturalistic fallacy”, observed by Hume who pointed out that “no logical rule of inference exists by which a sentence expressing moral obligation can be derived from a set of premises that are descriptive of the world or of human nature”. (Schaffner) This “ought” aspect of medicine can never be reduced to an “is” and subsequently can never be reduced to the biological sciences. Schaffner rightly points out that philosophers disagree on whether values such as “good” and “bad” can be specified in nonethical terms such as Mill attempts to in his theory of utilitarianism. However, this is a problem that is still unsolved in the much broader topic of ethics and is not specific to the reducibility of medicine. Such a big topic is beyond the scope of this essay but to suffice to say that it provides yet another potential barrier for the reducibility of medicine.
Having considered the arguments put forward by Munson and Schaffner, I would agree with Schaffner that “for the present and the foreseeable future medicine will not be a reducible science” and therefore, to answer our original question, a science at all. There is a possibility that with advances in the biomedical sciences and/or a resolution in the problem of naturalising ethical notions, we may one day be able to classify medicine as a science, but that day is not here yet. The uniqueness of medicine lies in its aims and principles and ultimately separates it from the traditional sciences. Of course, as Munson says, this does not lessen medicine in any way but rather provides a more correct and true account of the discipline.
Bibliography
MUNSON, R. “Why Medicine Cannot Be a Science,” The Journal of Medicine and Philosophy vol. 6:183-208 1981
SCHAFFNER, K. “Philosophy of Medicine,” in. M. Salmon et al. (eds.) Introduction to the Philosophy of Science, Indianapolis: Hackett Publishing Company 1999
