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HPLS (2015) 37(2):219–221

DOI 10.1007/s40656-015-0066-x

BOOK REVIEW

MAËL LEMOINE, La désunité de la médecine. Essai sur les


valeurs explicatives de la science médicale
Paris: Hermann, 2011, 235 p., € 29

Élodie Giroux

Published online: 18 February 2015


Ó Springer International Publishing AG 2015

In La désunité de la médecine. Essai sur les valeurs explicatives de la science


médicale [The Disunity of Medicine. An Essay on Explanatory Values in the
Medical Sciences], Maël Lemoine argues that medical explanations must be
distinguished from biological explanations. In so doing, he distances himself from
the earlier work of Kenneth Schaffner (Discovery and Explanation in Biology and
Medicine, 1993). And unlike Paul Thagard, who also supports the importance of this
distinction (How Scientists Explain Diseases, 1999), Lemoine stresses the role of
the recent development of epidemiology and evidence-based medicine in rendering
medical explanations different. Lemoine agrees with these authors about three main
characteristics of biomedical explanations, however, namely that they are middle-
range, multilevel and interdisciplinary.
The point of departure of Lemoine’s pluralism is the multidisciplinary nature of
medicine itself. Far from reflecting an immature stage of scientific development,
Lemoine considers it as a sign that pluralism—and the convergence of types of
evidence—is precisely at the core of the scientific method in medicine. The concept
of ‘‘explanatory values’’ is introduced by the author to elucidate the nature and
limits of the different domains of medical knowledge or types of explanation that
more or less correspond to the limits of medical disciplines, but not necessarily so.
For Lemoine, ‘‘explanatory values’’ mean ‘‘elucidatory belief’’ (p. 11), as they
determine the framework in which a specific explanation appears to be complete. It
is a ‘‘value’’ because it includes some theoretical beliefs that are not empirically
justifiable.
Chapters 2–6 examine five of the main domains of medical knowledge unified by
an explanatory value. This partition relies on the satisfactory character of an

É. Giroux (&)


Université Jean-Moulin Lyon 3 & Institut de Recherches Philosophiques de Lyon, Lyon, France
e-mail: elodie.giroux@univ-lyon3.fr

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220 É. Giroux

explanation rather than on the traditional disciplinary division: clinical, pharma-


cologic, epidemiological, mechanical, and biological explanations. The most
original and innovative part of the book is Chapter 2, on clinical explanation.
There, it is argued that far from being reducible to a mere act of observation the
clinical approach produces specific clinical explanations. At their core is the
identification of the disease from particular signs and symptoms, i.e. the assignation
of particular cases to natural kinds or categories. Such an explanation is not trivial
even if it can be seen as purely nominal: a diagnostic is always a matter of choosing
one category rather than others, namely the category that best explains the overall
clinical picture.
The pharmacologic explanation, in turn, and as Chapter 3 explains, does not seek
to explain the effect, i.e. all the events produced by the drug in the organism, but the
action of a drug, i.e. all the events that are relevant for a specific therapeutic goal. A
series of explanatory conditions (therapeutic intentionality, affinity, simplicity and
experimental substitution), necessary for a drug to be an active principle and
required for a pharmacological explanation to be satisfactory, are explored and
discussed further by the author.
Chapter 4, on epidemiological explanations, examines the conditions a statistical
explanation must satisfy (i.e. non-ambiguity). Like clinical explanations, epi-
demiological explanations are non-causal. They explain a singular fact with two
sentences (one singular the other universal) that indicate an association between two
variables (e.g. to smoke and to develop cancer). This association constitutes a
satisfactory explanation if (1) the correlation is statistically significant; if (2) the
study design is rigorously controlled against its potential bias; and if (3) the
characteristics that are associated are precisely defined.
In contrast, mechanical explanations, explored in Chapter 5, are not specific to
medicine but discovering mechanisms is so important in the biomedical sciences
that it is often seen as its major and most central type of explanation. Lemoine
extracts three main conditions that any mechanical explanation must satisfy: the
geometrical dimension, the quantification, and the mechanical causation itself.
Chapter 6 concerns the role of biological explanation in medicine. Here, biology
comes across as having an explanatory interest in medicine rather than as being the
scientific foundation on which to ground the legitimacy of medicine. Lemoine
shows the extent to which different biological explanatory values are used—and
transformed—in medicine. What is considered a satisfactory explanation in
infectious disease biology, genetics, cellular biology, and molecular biology, for
example, is not necessarily so in a medical or clinical context.
The last chapter draws out some implications from the analysis of the five main
medical explanatory values. Explanatory pluralism in medicine, Lemoine argues,
leads to disunity. Firstly, the relation of the different types of explanation is
described: they can be parallel, convergent, divergent, or complementary. Within
the complementary sort of relation between explanations, some can be dependent,
independent or subordinated. Such disunity of medicine does not necessarily imply
inconsistency or irreducibility in principle. Disunity is taken as a fact, not as a
principle, and is further considered to be compatible with realism. Secondly, some
implications for the theory of evidence in medicine are developed. Plurality and

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La désunité de la médecine 221

convergence of types of evidence are precisely the core scientific method of


medicine. And such convergence is possible precisely because of the irreducibility
of the several types of medical explanations.
Let me finish with a few critical remarks. The main one concerns the vagueness
of the notion of ‘‘explanatory values’’. What exactly is empirically unjustifiable in
this notion? There is some degree of vagueness and ambiguity with respect to the
nature of the relation between the type of explanation (e.g. mechanical vs.
statistical), the domain of investigation (cells, organisms, populations, normal or
pathological phenomena, etc.), the explanatory value (clinical, pharmacologic,
epidemiological, mechanical, and biological) and the medical sub-discipline
(infectiology, epidemiology, radiology, dermatology, nephrology, etc.). Exploring
the relation of ‘‘explanatory values’’ to Kuhn’s ‘‘paradigms’’ and to Hacking’s
‘‘styles of reasoning’’ could have been fruitful for clarifying the notion and its
relation to disciplines.
Another issue relates to the choice of the term ‘‘disunity’’. In the philosophy of
science, the notion of ‘‘disunity’’ refers to an ontological and metaphysical thesis
that is clearly not endorsed here. One could therefore question whether this term is
the correct one. Why not using ‘‘pluralism’’ in medicine instead? Additional
comments by the author regarding the meaning assumed for the central notions of
causality and explanation, and their articulation, could have been helpful. More
precise discussion about the relations between the author’s theory of explanation
and the pragmatic conception, on the one hand, and the unificationist account (of
explanation), on the other, would have also been welcome.
To conclude, I should say that this book is a very innovative and stimulating one.
Examining the nature of medical explanation and developing models of explanation
that are sensitive to disciplinary differences, it will be of interest to philosophers of
medicine as well as to philosophers of science more generally. I strongly
recommend it to anyone interested in the philosophy of medicine. It is a nice
way to enter into the field through the philosophy of science’s door.

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