Philosophical Issues in Medicine and Psychiatry, Part IV

This article, the last in a 4-part series on philosophical problems in conventional and integrative medicine, focuses on problems related to deriving methodologies for identifying integrative assessment and treatment approaches. Methodologies used to verify claims made for a particular conventional or nonconventional approach can be regarded as empirically derived, consensus-based, or intuitive. I show that conventional and non-conventional approaches are equivalent in terms of verifiability when a postulated mechanism of action cannot be empirically validated but replicable positive outcomes are confirmed. The broad philosophical problem of evidence in medicine can be reframed as the problem of deriving a methodology for determining criteria that can be used to verify assessment specificity or treatment effectiveness in relation to claims of outcomes associated with a particular modality. The conceptual basis of integrative medicine cannot be derived from first principles through analysis of core assumptions because disparate systems of medicine ultimately rest on irreducible metaphysical propositions about space, time, causality, and the nature of phenomenal reality. The conceptual framework of a practical integrative methodology is therefore limited to certain kinds of observable phenomena and measurable outcomes associated with particular assessment and treatment approaches used in disparate systems of medicine. Disparate empirically derived or intuitive approaches in diverse cultures have led to different understandings of the causes or meanings of illness in disparate systems of medicine. Illnesses regarded as legitimate diagnostic entities in one system of medicine are frequently at odds with accepted diagnostic categories in other systems of medicine. I argue that—within limits imposed by technology, economics, and availability of qualified practitioners—there will be optimum integrative assessment or treatment strategies with respect to particular symptoms. Conceptual, technological, and cultural constraints on efforts to establish integrative approaches depend on the parent system of medicine in which integration is taking place. Because medical practitioners can construct optimum integrative strategies only from the perspective of the system of medicine in which they are trained, all integrative strategies are inherently limited.