This rather unusual book is essentially an introduction to the Philosophy of Medicine. More specifically, it is an account of Medical Epistemology. Its aim is to elucidate the philosophical underpinnings of both clinical reasoning and biomedical research. The author is a philosopher in addition to being an eminent neurologist, and the book reflects both elements of the author’s background.

Right from the beginning, the author makes no attempt to hide the fact that he considers much of medical reasoning to be based on shaky logical foundations. He illustrates the problem by showing how many common patterns of medical reasoning, particularly inference, depend on a pattern of reasoning that is logically fallacious. But he stops short of claiming that the majority of medical reasoning is therefore invalid. On the contrary, he comes to the paradoxical-sounding conclusion that without the use of logical fallacy, medical reasoning would be largely meaningless since it would just consist in stating tautologies.

From this unlikely (Kantian?) beginning, the author goes on to argue that many other types of reasoning than logic are needed to construct the edifice of modern Medicine. Statistics, in particular, is highlighted as a way to quantify the extent of our confidence in drawing particular conclusions. The legal framework within which all doctors practice is viewed by the author as lacking teeth when it comes to the enforcement of the highest standards in clinical care and research. Only Ethics possesses the cogency to drive doctors forward to be the best they can. Ethics therefore comes to play a key role in medical reasoning.

So, medical reasoning is presented as a complex interaction of different reasoning styles. Complexity appears to be the hallmark of an epistemology of medicine.

The text is a stimulating account that is suitable for doctors or others involved in the healthcare endeavor who would like to understand what the true nature of medical reasoning is. It is a far cry from the picture of absolute certainty that some practitioners may seem keen to project. But this is in no way a dismissal or nihilistic account of modern Medicine. It has an upbeat tone and clearly shows the author’s optimism about how well-intentioned clinical endeavor informed by humility about the true extent of our knowledge can still lead to great advances in Medicine.

What the book is not is a textbook for anyone who wishes to have an immediately applicable framework with which to critique a specific example of medical reasoning. The author has made an attempt to contextualize the argument in the light of particular clinical or research scenarios, but much of the text still remains highly theoretical in nature.

In my opinion, this book is not an easy read. It is, however, a book that will repay the effort needed to understand a complex and challenging subject. Readers who have an interest in philosophy will find much to stimulate them and make them seek fuller answers.

© 2019 Max Hughes

Max Hughes is a former member of the Royal College of Psychiatrists and a retired locum consultant psychiatrist. He lives in Turkey.