Ho’s overall purpose (p. ix) is to examine some relationships among reality, appearance, and value, in order to determine whether and which values can, do, or should motivate science and influence medicine. Accordingly, he identifies, describes, and judges several presuppositions underlying the practice, art, and science of medicine. His analysis considers the ethical implications of each such presupposition.

The first of these presuppositions is that medicine is a science. Ho’s discussion of verificationism in this context (p. 9-13) puts him at pains to explain the difference between science and pseudoscience. He uses Popper toward this end, but his selective and narrow interpretation of the falsifiability principle and its detractions nearly sets up Popper as a straw man (p. 13-19). On Ho’s view, Popper argues against inductive reasoning as if all universal judgments from it were not only not verifiable, but also instances of hasty generalization. But Popper’s primary object of inquiry in this regard was testability, not induction, and the point of the falsifiability principle is not so much an attack on induction as a constructive program for testability. For example, that the specific gravity of gold is 19.32 was originally an inductive judgment. This judgment has since become part of the definition of gold and cannot be falsified. If we ever find “gold” with a different specific gravity, then we should not announce that we have discovered a new kind of “gold,” but hypothesize that either the sample contains impurities or is something other than gold.

Propositions in pseudoscience, such as “Prayer works,” are neither verifiable nor falsifiable and are typically subject to the post hoc ergo propter hoc fallacy. No proposition in pseudoscience can be either verified or falsified, but must be either accepted on faith or, in the spirit of healthy skepticism, rejected because it is neither verifiable nor falsifiable. Only one discrepant instance proves a proposition false, but to prove it true, we would have to examine every possible instance, which is impractical at best, more likely impossible, and with pseudoscience, absolutely impossible.

In the next chapter, Ho examines a pair of conflicting presuppositions: (1) that health and disease are value-free and that disease is the biologically determinable absence or deterioration of health, vs. (2) “that health and disease can be understood only in terms of our values” (p. 29). The ontological question of the difference between health and disease (if there even are such entities) is at least as old as Aristotle and was especially prominent in the nineteenth century as medicine grew out of superstition, nosology, etc., into science informed by anesthesia, antisepsis, microscopy, germ theory, etc. Nevertheless, Ho is not doing ontology, but rather axiology and sociopolitical analysis, and is quite justified in so doing because indeed there are inevitable – and often neglected – axiological dimensions and sociopolitical ramifications of our concepts of health and disease (p. 27). Words such as “health” and “disease” are necessarily relative and cannot avoid having value-laden connotations and even, Ho argues, denotations (p. 28-29).

The history of medicine shows clearly that the relative definitions of disease, disability, illness, pre-existing conditions, etc., on the one hand, and health, wellness, soundness, etc., on the other, have become political rather than ontological, or perhaps have always been political. Ho cites homosexuality as an example of a condition which is no longer regarded as a disease because our sociopolitical values have shifted toward tolerance (p. 29). Even better examples of such shifts in value-laden definitions – which Ho does not mention – are the medieval vice of acedia, which is now seen as a species of clinical depression, and the tendency of slaves to run away from their masters, which in antebellum Dixie was known as the disease of drapetomania.

The topic of Chapter 3 is evidence. Ho reminds us that justified true belief alone is not sufficient for knowledge (p. 45, 47), which must also involve some “additional condition” to make a belief “epistemically superior” (p. 47). He does not conclude what this condition might be, but asks further questions about the relation between evidence and value, noting that evidence is neither objective nor value-free, and in many cases may not even be reproducible or verifiable.

Given this failure of evidence to produce certain knowledge, Chapter 4 accordingly considers the process and results of explanation, showing how explanatory criteria can be skewed, tweaked, or made to serve sociopolitical, medical, or psychological ends. Ho is concerned here mainly with the “many ways an observation can fail to connect to our set of beliefs” (p. 83).

Chapter 5 discusses probability and argues that even the analysis of chance is not strictly mathematical. Ho claims that Laplace’s principle of indifference (p. 94-98) cannot apply to biomedical research because there are simply too many variables in clinical trials for purely mathematical probabilities to be reliable. Insofar as these variables include socioeconomic, sociopolitical, individual, idiosyncratic, and other uncontrollable contingencies, Ho’s argument here seems cogent. Even if it were possible to account for all such contingencies before testing began, values would creep into the analysis after the data was gathered.

Hence Chapter 6 asks whether value-free science or medicine is possible and, if so, whether it is desirable. We may be dealing not with an abrogation of values, but with a shift in values, such that the traditional distinction between fact and value becomes blurry at best (p. 118-119).

The seventh and final chapter answers that science cannot avoid values (p. 134) and that they are not necessarily negative, undesirable, or contaminating. Indeed they can be constructive and beneficial if we recognize, understand, contextualize, and use them pragmatically in the benevolent spirit of medicine.

Ho’s pleasant conversational style gives the reader an engaging, almost interactive book with plenty of historical, clinical, and laboratory examples and illustrations presented with flair and humor. His book would sparkle if it were not so poorly edited. This is the fault of the publisher, not the author, whose good work is marred by a myriad of annoying little errors, e.g., misspelled words, misalphabetized references, no space between the period at the end of one sentence and the capital at the beginning of the next, Hume represented as lamenting that all his publications “fell deadborn from the press” (p. 92) when in fact it was only the Treatise. Worst of all is the index, which is sketchy, haphazard, and incomplete. If the text mentions a name or topic on, say, eight pages, the index typically lists only one or two. Ho deserves better.

© 2020 Eric v.d. Luft

Eric v.d. Luft earned his B.A. magna cum laude in philosophy and religion at Bowdoin College in 1974, his Ph.D. in philosophy at Bryn Mawr College in 1985, and his M.L.S. at Syracuse University in 1993. From 1987 to 2006 he was Curator of Historical Collections at SUNY Upstate Medical University. He has taught at Villanova University, Syracuse University, Upstate, and the College of Saint Rose. He is the author, editor, or translator of over 650 publications in philosophy, religion, librarianship, history, history of medicine, and nineteenth-century studies; owns Gegensatz Press; and is listed in Who’s Who in America.

Categories: Philosophical

Keywords: medicine, philosophy