Klement, Rainer J. and Bandyopadhyay, Prasanta S. (2019) Emergence and evidence: a close look at Bunge’s philosophy of medicine. [Preprint]

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Abstract

In his book “Medical Philosophy: Conceptual issues in Medicine“, Mario Bunge provides a unique account of medical philosophy that is deeply rooted in a realist ontology he calls “systemism”. According to systemism, the world consists of systems and their parts, and systems possess emergent properties that their parts lack. Events within systems may form causes and effects that are constantly conjoined via particular mechanisms. Bunge supports the views of the evidence-based medicine movement that randomized controlled trials (RCTs) provide the best evidence to establish the truth of causal hypothesis; in fact, he argues that only RCTs have this ability. Here we argue that Bunge neglects the important feature of patients being open systems which are in steady interaction with their environment. We show that accepting this feature leads to counter-intuitive consequences for his account of medical hypothesis testing. In particular, we point out that (i) the confirmation of hypotheses is inherently stochastic and affords a probabilistic account of both confirmation and evidence which we provide here; (ii) RCTs are neither necessary nor sufficient to establish the truth of a causal claim; (iii) testing of causal hypotheses requires taking into account background knowledge and the context within which an intervention is applied. We conclude that there is no “best” research methodology in medicine, but that different methodologies should co-exist in a complementary fashion.

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Item Type:	Preprint
Creators:	Creators Email ORCID Klement, Rainer J. rainer_klement@gmx.de 0000-0003-1401-4270 Bandyopadhyay, Prasanta S. psb@montana.edu
Keywords:	Bayesianism; confirmation; evidence; evidence-based medicine; Mario Bunge; systemism; systems thinking; philosophy of medicine; philosophy of science
Subjects:	Specific Sciences > Medicine > Clinical Trials General Issues > Evidence Specific Sciences > Medicine
Depositing User:	Dr. Rainer Klement
Date Deposited:	28 Jun 2019 20:18
Last Modified:	28 Jun 2019 20:18
Item ID:	16157
Subjects:	Specific Sciences > Medicine > Clinical Trials General Issues > Evidence Specific Sciences > Medicine
Date:	27 June 2019
URI:	https://philsci-archive.pitt.edu/id/eprint/16157

Available Versions of this Item

• Emergence and evidence: a close look at Bunge’s philosophy of medicine. (deposited 28 Jun 2019 20:18) [Currently Displayed]
  • Emergence and evidence: a close look at Bunge’s philosophy of medicine. (deposited 07 Apr 2020 02:12)

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