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Abstract

The ontology of medicine—the question of whether disease entities are real or not—is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.

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Notes

  1. While there is a field called “biomedical ontology” with its own National Institutes of Health (NIH) center (The National Center for Biomedical Ontology), it is a branch of medical informatics concerned with creating a controlled unified vocabulary for medical categories with specified relationships between the terms in that vocabulary. While not entirely divorced from philosophy, it does not address the questions I am interested in here.

  2. See Simon [21] for an extensive treatment of the various positions.

  3. Examples of these positions can be found, respectively, in [8], [13], [5], and [7].

  4. This example is from [5].

  5. The current brouhaha over global warming is so striking precisely because, in general, science is immune from these sorts of public debates. Were such extra-scientific responses to scientific debate the norm, this debate would not be particularly remarkable. I would also note that, in many ways, geology and meteorology may be even further from paradigmatic science than (a realist) medicine, in particular because of its relative lack of an experimental base. The public response to it, in this case, is therefore not a strong counter example to the elevated status I have claimed here for paradigmatic science.

  6. Although science itself may well be undergoing a decline in social stature, I think it is clear that scientific announcements and discoveries retain a special place in our culture.

  7. Modern medicine does draw on molecular and even, perhaps, population genetics, both of which may well be counted as theories. However, neither of these can be considered a theory of medicine in the requisite sense. Molecular genetics is a theory of certain biochemical processes, and population genetics is a theory of the distribution of traits. While medicine may make use of some of the results revealed by these theories, it is in no way committed to the literal truth of the theories.

  8. Although some features of a condition, say, a rash, may be observable, if there is more to a condition than its physical signs, the condition itself, say, the scarlet fever, will not be directly observable.

  9. The only modern exception to this statement may be early germ theorists of disease, who identified diseases (i.e., conditions) with their causes. Thus, tuberculosis was Mycobacterium tuberculosis. For reasons beyond the scope of this article, this understanding of conditions cannot even be considered a potential (realist) approach to medical ontology.

  10. There may be more than one species concept, and it may even be that none of them is uniquely correct—see, e.g., Dupré [39] and Kitcher [40]—but this is a separate issue. Regarding a given species concept, realists about that concept believe that there is a single correct way…. Here and elsewhere I will avoid dealing with such complications in the philosophy of biology as the question of whether there is a single species concept and odd cases like clonal organisms and slime molds.

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Acknowledgments

The author would like to thank Profs. Fred Gifford, Mark Risjord, William Ruddick and Miriam Solomon, as well as the participants in the 2008 Philosophy of Medicine Roundtable at the University of Alabama-Birmingham, for helpful comments on earlier versions of this paper.

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Simon, J.R. Advertisement for the ontology for medicine. Theor Med Bioeth 31, 333–346 (2010). https://doi.org/10.1007/s11017-010-9153-x

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