Robin J Evans
Medicine has perfected the appraisal of evidence while leaving the formation of concepts largely to chance. The crisis is not one of insufficient data but of insufficient ideas. New conceptions come from prepared minds, and history and philosophy are part of that preparation.
RATIONALE, AIMS AND OBJECTIVES: Medicine has never possessed more data, yet the conviction that understanding has deepened with it is difficult to sustain. This paper argues that the shortfall is conceptual rather than empirical and turns to the philosophy of science of William Whewell to name it. Evidence-based medicine tells clinicians how to weigh evidence once it is in hand. The paper aims to show that Whewell describes the earlier and harder task, the forming of the conceptions that make observations count as evidence in the first place.
METHOD: The analysis is conceptual and historical. Whewell held that facts do not organise themselves but require colligation, the superinduction of a clarifying conception upon observations, and that discovery is most strongly warranted by consilience, the convergence of independent classes of fact upon a single cause. His account is read alongside Peirce on abduction and Fleck on how a scientific fact is held in place, illustrated through a case history of craniosynostosis from Virchow's law to the FGFR discoveries of the 1990s and applied to precision medicine, subspecialisation and artificial intelligence.
RESULTS: In craniosynostosis, children moved between diagnostic categories and a new syndrome came into being without a single new observation, because a conception arrived that reorganised what existing observations were observations of. The contemporary difficulties are versions of the same problem. Precision medicine has delivered where a true cause was secured and stalled where it offered only correlation. Subspecialisation fragments enquiry so that consiliences crossing organ systems go unrecognised. Artificial intelligence extends the power of observation without extending the power of conception.
CONCLUSION: Medicine has perfected the appraisal of evidence while leaving the formation of concepts largely to chance. The crisis is not one of insufficient data but of insufficient ideas. New conceptions come from prepared minds, and history and philosophy are part of that preparation.