203. IN THE DARK - Medicine, Epistemology and Economics

Just a quick one this week as I’ve been having some health issues lately which have taken up some of the time I would usually set aside to write one of these things. But actually the process of trying to find out what is wrong with me is an interesting example of applied philosophy.

I always tell students when discussing epistemology that law and medicine are two everyday examples of inductive reasoning at work. We do not know who committed the crime, or what is causing the symptoms, but we have to put together an argument of best hypothesis - is it more likely to be caused by A, B or C.

But in actual fact sometimes inductive inference is not required. Sometimes we can deductively entail guilt or sickness. If CCTV footage literally shows person X robbing the bank, we do not need to cobble together theories about whodunnit. The principle of indiscernability of identicals works sufficiently to tell us that if X is you, and X is robbing the bank, then you robbed the bank. Likewise, sometimes a blood test, a urine test, a biopsy, a saliva sample, can show up certain indicators which mean a certain medical condition definitely is present. The presence of indicator Y entails illness Z.

My own medical issues are currently in the inductive phase; looking at symptoms and ruling out certain plausible causes one by one. But they are getting to the more deductive phase as easy possibilities are ruled out one by one. Watching the process, it struck me that the inductive guesswork of medicine is many ways merely an economic process. Can we figure this thing out cheaply, without the need for expensive tests and lab work, or do we need to pay the extra for more certainty? Is it worth it to know, or will our best hypothesis do?

In countries where private healthcare rules, we see the opposite problem: over-testing and the charging for multiple unnecessary expensive medical tests and procedures. Such countries seem to produce a high level of ‘knowledge’ around healthcare because they get to deal frequently in actual numbers and chemical indicators of disease. But they also create a whole industry around exploitative wellbeing, identifying with alleged certainty healthcare issues which, perhaps, lie within a tolerance of the human experience and yet now have an (expensive) treatment available.

The point is that, under capitalism, truth is expensive. Finding out accurate answers about what is actually happening to our bodies never comes for free. Even the inductive reasoning, after all, is only possible after an expensive multi-year education in medicine. Take the expensive education away, and all we have is internet-based self-diagnosis (hence why it is always cancer online).

I have long railed against the economic barriers to basic essentials for human survival that are put in place by capitalism. Food, water, shelter, clothing, etc., all coming at a price instead of being freely available to all. But I wonder if the economics of medicine are too-often overlooked, even in countries with a decent free public healthcare system. I wonder how many people have lived or died because of investigations presenting as questions of epistemology - how can we possibly know what is going on in this body? - which are actually questions of finance - can we justify the expenditure it would take to find out?

Author: DaN McKee (he/him)

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