Philosophical Problems in Medicine and Psychiatry, Part III

40 Lake—Philosophical Problems in Medicine and Psychiatry This is the third in a 4-part series on philosophical problems in medicine and integrative medicine. The article reviews basic questions pertaining to the evidence base in science and medicine in general. Most conventional and non-conventional medical approaches are used without compelling evidence for their postulated mechanisms of action. I argue that it is not possible to construct a common philosophical framework unifying the basic metaphysical assumptions of biomedicine and non-conventional systems of medicine at a conceptual level. I show that metaphysical assumptions embedded in any particular system of medicine cannot be independently verified as more or less true, but only shown to have greater or lesser degrees of internal coherence with respect to the system of thought to which they belong. In a practical vein, the evolution of a particular system of medicine toward greater integration with disparate healing traditions is determined by social, economic, and political issues; local factors that influence access to care; and patient preferences. Assumptions about causality determine perceived legitimate meanings of “assessment” and “treatment” from the perspectives of individual healing traditions, and different assumptions about causality in individual systems of medicine bias understandings of “evidence.”