Medical Explanations in Evolutionary Medicine, Network Medicine, and Medically Unexplained Physical Symptoms

摘要

This dissertation is a philosophical exploration of the limits of medical explanations. I examine three case studies to explore these limits: evolutionary medicine, network medicine, and the medically unexplained. Evolutionary medicine and network medicine exemplify modern attempts to develop new explanatory strategies in clinical research and practice. They are burgeoning, nascent fields that challenge our conventional understanding of health and disease. I am critical of the former and optimistic about the latter. I argue that the ultimate explanations posed by evolutionary medicine are pragmatically and epistemically inadequate as medical explanations. Explanations that appeal to our ancestral past are speculative, often based on adaptationist assumptions, and empirically suspect---we cannot rely on them to develop medical interventions. Network medicine aims to map the connections between the causes of disease and pathophenotypes. It has the potential to reconceptualize diseases as emergent topologies of these networks. I discuss the role of mechanisms in these models and how multi-level, context-sensitive networks aim to be empirically robust. Medically unexplained syndromes, in contrast, are an obscure class of illnesses that cannot be explained by somatic biomedicine. Like complex chronic diseases, these syndromes are a thorn in the overwhelming success of medical progress. Patients with unexplained syndromes are often diagnosed with psychiatric illnesses, and I argue that it is an epistemic injustice to pathologize such gaps in medical knowledge. Rather than diagnosis these conditions by exclusion, we need to embrace epistemic humility when confronted with such medical uncertainty. This dissertation adds to the literature on medical explanations, exploring their unique virtues and clinical implications.