In claiming that facts are ever-changing due to various influences (i.e. social, political, religious, etc.), Fleck addresses the dynamic view of diseases (such that they change in their nature over time). Smith, on the other hand, rightly makes the distinction between “science” as based on facts and “medicine” as derived from a variety of social contexts. This distinction negates Fleck’s epistemological theory of ‘facts’ as continuously evolving thoughts that conceal truth. For instance, the fact that ‘water is H2O’ may not have been discovered until the development of molecular theory, but the fact still remains the same: water is two parts hydrogen, one part oxygen (without getting into the many complications of organic chemistry). One might argue, in support of Fleck, that this fact is the same as the fact of ‘syphilis is a disease given to humans by God’ (Fleck, 10). However, that ‘syphilis is a disease’, is a fact that has not changed, neither has ‘60% of our bodies are water’. Both these facts may be based in the social context of structures of linguistic systems, in the case of the former, and the context of human definition in the case of the latter (such that ‘water’ can be replaced with ‘H2O’ post the development of molecular theory). Specifically, while the perception of the fact that ‘syphilis is a disease’ has changed throughout history, it has not changed the basic idea: syphilis is in fact a disease. Hence, Fleck’s conception of fact, thoughts and perceptions of facts seems to capture the problems with the definitions of specific diseases, as they change with time, but it does not capture any epistemological inaccuracy of fact based judgments used as prerequisites in understanding the scientific structure of diseases.
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