Barbara Forrest’s “The non-epistemology of intelligent design: its implications for public policy”¹ is at the center of what has been dubbed “The Synthese Affair“. The bulk of her paper is a sustained and often dismissive account of Francis Beckwith’s arguments in support of Intelligent Design. Although I think Forrest’s attacks constitute a relatively minor transgression of academic norms, I find myself perplexed by some (though by no means all, or even many) of her substantive arguments. I will be teaching a unit on Intelligent Design for an undergraduate course this year, so the purpose of this post is to sort out my ideas on some issues. I would greatly appreciate feedback.

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In Heather Douglas’s Science, Policy, and the Value-Free Ideal (you can find a video of Douglas speaking about her book here), she claims that there is no practical way to draw a distinction between scientists-as-scientists and scientists-as-advisors. That is, you cannot cleanly separate the descriptive, empirical claims of scientists from their prescriptive advice. Mainstream philosophy of science, she claims, has gone astray since the 1940s in supporting a view of science as value-free, and scientists as detached and objective. Douglas not only argues that we need to acknowledge the unavoidable value-ladenness of science, but that values are not necessarily a negative influence on science. Rather, scientists have an ethical obligation to make value judgments in their work.

Here is one of her examples:

Suppose a scientist is examining epidemiological records in conjunction with air quality standards and the scientist notices that a particular pollutant is always conjoined with a spike in respiratory deaths. Suppose that this pollutant is cheap to control or eliminate (a new and simple technology has just been developed). Should the scientist make the empirical claim (or, if on a science advisory panel reviewing this evidence, support the claim) that this pollutant is a public health threat? Certainly, there is uncertainty in the empirical evidence here. Epidemiological records are always fraught with problems of reliability, and indeed, we have only a correlation between the pollutant and the health effect. The scientist, in being honest, should undoubtedly acknowledge these uncertainties. To pretend certainty on such evidence would be dishonest and deceptive. But the scientist can also choose whether or not the emphasize the importance of the uncertainties (81).

Douglas presents this as a slam-dunk case, and has constructed the situation, by assuming a cheap and easy fix, to be unproblematic. However, I find the implications of this argument deeply troubling.

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History and Philosophy of Science, even by academic standards, is a somewhat obscure discipline of the humanities.  The march of science and technology often seems to proceed regardless of any commentary, critique, or analysis from historians, philosophers, sociologists, and even policymakers. So why think there is any potential for a history and philosophy of science to become “socially relevant”?

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Physicians are trained in a science of particulars. Your bodily experiences might be unique, your preferences deserving of personal care, and your history worthy of a docudrama… but the medical evidence at your bedside was gathered in a freeze-framed panorama: randomized, controlled, and blinded. This is the science of particulars: big-picture studies that have to be individualized for you. And me. This is evidence-based medicine.

But how does this landscape represent you — person and patient?

Lets begin with semantics. What’s the difference between patient-centered, person-centered, and personalized medicine?

Patient-centered medicine revitalizes a patient’s values, preferences, and autonomy. It brings respect for patient decisions back into the clinical equation.

Person-centered medicine treats patients as… persons. Persons can suffer, worry, and hope unlike their objectified and medicalized counterparts: diseased patients.

Personalized medicine aims to truly be that science of particulars: customizing diagnoses, treatments, and prognoses based on your unique biological (i.e. genetic) architecture. Your SNPs have so much to say.

Do any of these epistemic stances make medicine more than just personalized, but personalizable? I’m not so sure. Lets leave that up for debate.