There exists a divide among philosophers of science – likewise among philosophers of medicine – between realism and antirealism. At bottom, this debate is over ontology, that is, the study and nature of “being”. In the philosophy of medicine, one of the questions becomes what is the ontological status of a disease? Each side has its set of favoured intuitions that support their position, but neither side seems to be able to capture all of our commonsense intuitions that often straddle the divide. In response, Jeremy Simon proposes that we adopt a constructive realist approach to medical ontology that is better able to capture those seemingly conflicting intuitions that support the realist-antirealist divide.
Realists are keen to maintain their position because their stance explains the congruence between scientific practice of identifying a disease with the underlying reality, thus allowing for medical success and advances. If two cases of the same disease were not really the same, how could we explain our success in treating similar cases with similar treatments? Antirealists respond by saying that the realist position is not able to account for variations between patients with the same disease. How can two patients be said to have the same disease, when there exists such vast differences between them?
Simon’s constructive realist ontology attempts to bridge the gap by employing an abstract modeling system in which case models represent the underlying causal structure of the world in a modal structure. By employing a causal strategy, the constructive realist model is able to account for success and advances in medicine, while allowing for differences between patients since models only require that patients are similar in some respects and to a limited degree.
While Simon’s strategy is able to capture both sets of intuitions – and seems to mirror our commonsense intuitions – his reliance on the causal structure of diseases could prove to be problematic. Models are able to succeed in the domain of physics because mechanistic laws govern the inorganic reality, but organic entities may not share the same regularity upon which Simon’s proposed alternative depends