Explanatory pluralism in the medical sciences: Theory and practice

Abstract

Abstract:Explanatory pluralism is the view that the best form and level of explanation depends on the kind of question one seeks to answer by the explanation, and that in order to answer all questions in the best way possible, we need more than one form and level of explanation. In the first part of this article, we argue that explanatory pluralism holds for the medical sciences, at least in theory. However, in the second part of the article we show that medical research and practice is actually not fully and truly explanatory pluralist yet. Although the literature demonstrates a slowly growing interest in non-reductive explanations in medicine, the dominant approach in medicine is still methodologically reductionist. This implies that non-reductive explanations often do not get the attention they deserve. We argue that the field of medicine could benefit greatly by reconsidering its reductive tendencies and becoming fully and truly explanatory pluralist. Nonetheless, trying to achieve the right balance in the search for and application of reductive and non-reductive explanations will in any case be a difficult exercise.

Indispensability Arguments in Favour of Reductive Explanations

“…The importance of genetic or molecular details to address some specific epistemic interests in the biomedical sciences, attracts the attention of reductionists; pluralists will emphasise the non-genetic and non-molecular remedies (which put the heterogeneity of underlying molecular levels between brackets) to be found on higher levels (cf. De Vreese et al, 2010). In the social sciences, reductive explanations invoking biological factors can address questions (and epistemic interests) left unanswered by higher-level explanations.…”

The new medical model: a renewed challenge for biomedicine

“…7 Similarly, in medicine, patient care is often described as reductionistic when it is oriented toward or organized around body parts instead of treating the whole patient in their life context. Together, the new medical model's disease concept and its disease-centred ethic promote reductionism, because diseases are understood with reference to the body's component parts, and the goal is to cure, prevent or manage the disease.…”

“…7 For example, given the importance of psychological and social factors in the prevention and management of chronic maladies, it is worthwhile exploring whether chronic diseases and their pathogenesis are best understood -and even best defined -at psychological and social levels in addition to biological levels. However, how can we define multilevel chronic diseases and pathogenesis in a substantive way that facilitates effective prevention and management and goes beyond simply listing social determinants?…”

How to Study Scientific Explanation?

“…They can also try to provide guidelines for improving an explanatory practice. Examples of this can be found in Weber (2008a) and(2008b) and in De Vreese, Weber & Van Bouwel (2010). These papers engage in debates on explanatory practices in the social sciences and in the biomedical sciences.…”