Miriam Solomon’s latest work, “Making Medical Knowledge,” examines how it’s never just an “either/or” with art and science. Both play a role in advancing medicine.
by Sara Curnow Wilson
Like many College of Liberal Arts students and faculty, Miriam Solomon thrives in an interdisciplinary environment as she pushes the limits of her field—and her new book, recently published by Oxford University Press, does just that. “Making Medical Knowledge” examines the medical humanities by investigating how new medical knowledge is created.
We sat down with the philosophy professor and department chair to discuss her latest work, the divide between science and art and how she’s seeking to advance medical studies.
In your book, you argue that the conceptual divide between “science” and “art” limits the understanding of modern medicinal practices. Can you explain how this divide has existed historically?
The idea that medicine involves both “science” and “art” goes back to Greek thought, but it has been particularly prominent since the late nineteenth and early twentieth century, a time often described as “the birth of scientific medicine” because of the experimental methods developed and the discoveries (in microbiology, physiology, pathology, anesthesia, antisepsis, and surgery) that transformed the practice of medicine.
While the new scientific discoveries and methods were exciting, many felt that the focus on microbes and microscopes devalued both the humanity of the patient and the humanism of the physician. Medical students today still read a 1927 article by Francis Peabody, who passionately advocated for medical education to include more than medical sciences. He is often quoted as saying, “The secret of the care of the patient is the care of the patient.”
Have recent epistemological approaches to medicine, what you call methods, widened or narrowed this disciplinary divide?
In some ways, the development of new methods in medicine has widened the disciplinary divide. The disciplinary contrast between so-called “scientific” approaches, such as evidence-based medicine and “art” approaches, such as narrative medicine, is immediately apparent. In other ways, the development of new methods shows that two categories—art and science—is not enough for describing important characteristics of both kinds of methods.
Furthermore, philosophers of science have discovered that science, in general, is not so different from the humanities; science has been idealized as more objective and law-like than it is in fact. The work of Thomas Kuhn in the 1960s stimulated this new work in philosophy of science, and I am extending it to philosophy of medicine.
How and why does your work rethink the science and art paradigm?
My work shows that the science vs. art paradigm is okay as a first approximation to understanding medical knowledge, but misleading when we explore things more deeply. It turns out that there is more than one way of being “scientific.” Some methods are difficult to classify as either “science” or “art.” And “science” is not so different from the humanities, and the humanities not so unscientific, as the science vs. art paradigm suggests. I argue that it is more helpful to think in terms of a plurality of methods.
Rather than focusing on one method, as recent book-length works in the field tend to do, you explore four different recent epistemological approaches to medicine. What does this approach allow you to do that would not be possible if you limited your scope to one method?
Actually, the book was originally intended to be a book about the use of consensus conferences in medicine—the first method discussed, which began at NIH in 1977. As I started thinking about how consensus conferences changed over time, I found that I had to discuss the impact of evidence-based medicine in the 1990s, which was a challenge to the epistemology of consensus conferences. Moreover, evidence-based medicine, while sounding obvious and straightforward, turns out to have some puzzling features, such as a hierarchy of evidence. It was also heavily criticized, especially by those who thought that it devalues the expertise of the physician and the individuality of the patient.
Narrative medicine is a recent development on the “art” side that claims to restore the human side of medicine. Translational medicine emerged in the early 2000s. As I understand it, it was a response to shortfalls with both consensus conferences and evidence-based medicine. Understanding the interrelations between the methods over time turns out to be a productive way of exploring their strength and their weaknesses. It also illustrates that medical knowledge, as a whole, is the result of a plurality of methods.
You suggest in your introduction that each method you discuss has something “obvious” about it and something “odd” about it. Can you elaborate?
Consensus conferences rest on the weight that we give to the opinion of experts, especially when they discuss the matter rationally and come to agree with one another. Yet there is something odd about the idea that scientific (rather than political) disputes could be settled in this way. When physicists disagree about a matter, say, the number of types of neutrino, they do not convene a consensus conference to discuss and settle the matter. Instead, they do more experimental research, or reanalyze the data, or theorize further. They do not expect 10-20 people seated around a table for 48 hours to be able to resolve scientific disagreements.
Evidence-based medicine at first seems to state the obvious—that medical knowledge is based on evidence—yet it has a precise (some think narrow, and some think refined) view of what counts as quality of evidence.
Translational medicine seems to be a new term for old practices of causal reasoning and trial and error intervention, yet it has been championed as a new method.
Narrative medicine emphasizes listening to the patient, which is widely regarded as good basic medical practice, yet also claims that listening with the tools of literary analysis, rather than simple commonsense, gives the physician the most information.
What are your goals with this book? What disciplines do you see it influencing? In other words, who can benefit from your findings, and how can your findings be applied in the real world?
This book is intended to advance “critical medical studies”—the use of broadly humanistic methods to criticize as well as to enrich medical knowledge. It is aimed at a wide and interdisciplinary academic audience, but it is also written to be accessible to both medical audiences and broader educated audiences. I hope that it helps with understanding medical controversies, which often result from methodological weaknesses of particular methods or from conflicts between the methods.
I hope that the ideas in the book are used to guide funding initiatives in medical research, improve medical education, and help with understanding the changing roles of physicians and other health care professionals.