Gustavo Bueno (1924-2016), el gran clasificador

“Crítica es clasificación”, decía Gustavo Bueno, el gran clasificador. Abra cualquiera de sus obras y lo más probable es que se encuentre una “teoría de teorías”, en la que sus propias ideas se oponen sistemáticamente a cualquier alternativa. Sólo un genio de la clasificación puede permitirse desafiar así las intuiciones de sus lectores. Bueno era materialista, pero, a diferencia de los materialistas vulgares, defendía la realidad de las ideas (un “género de materialidad”). El de Bueno era un ateísmo católico, en el que la tradición escolástica contaba tanto como la filosofía moderna (y bastante más que la contemporánea). A Bueno algunos le conocieron como falangista (en los 1940) y otros como marxista (en los 1970). De cualquier proyecto político a él le interesaba su implantación efectiva, y la universalidad de su alcance. Lo mejor: un Imperio. “De no ser por la Iglesia católica, el cristianismo habría sido una secta judía más”, decía. Caídas la Alemania nazi y la URSS, Bueno se las ingenió para argumentar que, en el siglo XXI, España es lo más parecido a un proyecto imperial que les quedaba a los filósofos sistemáticos-materialistas-ateos-católicos.

Nuestro gran clasificador era, por supuesto, inclasificable. Nadie se atrevió a mezclar tantas ideas como Bueno a propósito de tantos temas como tocó en su extensísima obra. Él se presentaba como un “compositor” en un medio académico de “intérpretes y arreglistas”, como el español. Suya fue la reivindicación de la Symploké ontológica (“No todo está relacionado con todo”), el cierre categorial (la verdad de la ciencia no es la correspondencia entre teoría y mundo: es una forma de organización del propio mundo a través de las operaciones del científico), el animal divino (el terror prehistórico ante el animal sin domesticar es el origen del sentimiento religioso), y un largo etc. Aunque Bueno no fue nunca demasiado cuidadoso al citar sus fuentes, muchos lectores adivinaban de dónde bebía. Pero eso no disminuye su mérito componiendo: ni en su generación ni en las siguientes encontramos semejante fusión de estructuralismo y escolástica, análisis lógico y fenomenología. Pretendiendo ser, todo el tiempo, más consistente que cualquiera de sus interlocutores, pues para eso –decía– sirve un sistema.

“Pensar es pensar contra alguien”, sostenía una y otra vez Bueno. Contra el propio Bueno, sin embargo, no ha pensado todavía nadie. Como sucede en cualquier escuela, los estudiosos de su materialismo filosófico suelen ser más arreglistas e intérpretes que compositores. Fuera de su escuela, nadie se ha tomado la molestia por ahora. Lo cual no dice mucho de sus méritos intelectuales. Así somos en España: ¿quién piensa hoy contra Zubiri, García Bacca, Amor Ruibal o García Calvo? Dice bastante, en cambio, de su implantación mundana. Como demuestran los obituarios publicados estos días, Bueno fue muy generoso con quienes se interesaban por su obra. Pero tenía también un talento enorme para excluirlos, si se distraían. Como a menudo le oí repetir a su hijo Gustavo, gestor de tantas de sus empresas académicas, al final “vale quien sirve”. Tan divertido como hiriente en el insulto, arbitrario en sus decisiones, atrabiliario en sus formas, muchos de sus colegas dejaron de tratar a Bueno (y de leerle) simplemente para evitarse disgustos. Yo entre ellos: duré dos números en el consejo editorial de su revista (El Basilisco), sin haber pedido ni entrar ni salir. “No se enfade usted, señor Bueno”, le rogaba el presentador en una de sus incendiarias intervenciones televisivas. “No me haga usted enfadar, que es muy distinto”, le respondía él, airado.

Gustavo Bueno podía enfadarse fácilmente y mucho. Lo cual, de nuevo, no prejuzga nada sobre el valor de sus ideas. El suyo no ha sido el único carácter difícil de la Historia de la filosofía y sus vaivenes políticos no son mayores que los de otras ilustres luminarias del XX. Bueno se quejaba de que él leía a todos sus colegas, pero ninguno le correspondía. Quizá les intimidase intelectualmente. Quizá temiesen su reacción si se atrevían a opinar. O quizá, simplemente, les aburriese. De lo que no se daba cuenta era de que no le pasaba sólo a él. Javier Muguerza, paradigma de la cortesía académica, decía a menudo eso de que “de los libros de los amigos no sólo hay que hablar bien; hay que leerlos”. Yo leí mucho a Bueno cuando era estudiante y sus tesis me parecieron siempre más interesantes que los de cualquier otro de sus coetáneos españoles, aunque sólo sea por menos aburridas/predecibles. Para una generación como la mía, que habla inglés y accede a Internet antes de salir de la Facultad, resultó fácil encontrar por ahí versiones mejores de casi cualquier argumento escrito en español en los últimos cincuenta años. Por una parte, porque somos muchos ya los filósofos de lengua española que usamos directamente el inglés para publicar. Por otro, porque al inglés se traduce más filosofía que a cualquier otra lengua. Entre todo lo que yo he leído, Bueno destacó siempre por la originalidad de sus argumentos.

Pero la originalidad no es todo lo que se debería buscar en un filósofo. Cualquier idea de las que interesaron a Bueno, y en particular todas las que se refieren a las ciencias, están discutidas con infinitamente más información y detalle en el mundo filosófico anglosajón. Tanta información y detalle que difícilmente darán lugar a un sistema tan ambicioso como el que pretendió construir Bueno. Aquí está el reto para su materialismo filosófico: ¿habrá entre sus discípulos algún otro compositor que acierte a ponerlo al día y obtener el eco académico que no obtuvo su fundador? ¿O como en tantos palacios de la antigüedad, los lectores de Bueno irán arrancando piezas de su sistema para levantar sus propios argumentos, ajenos ya a la composición original?

"El universo mudanza, la vida firmeza”, decía Bueno con los estoicos. Quizá algún día una biografía intelectual nos descubra cuánto cambió realmente Bueno en sus seis décadas de escritura académica. Hoy sólo podemos admirarnos de su fecundidad filosófica y recordar los buenos ratos que (a algunos) nos ha hecho pasar con sus diatribas. Si estáis contentos, aplaudid al actor.

{Contextos, agosto de 2016}

David Spiegelhalter, Sex by numbers, London, Profile books, 2015

For many, sex is more about quality than quantity, so David Spiegelhalter’s Sex by numbers may put off many potential readers.  Yet, in sex quantity seems to have a certain quality of its own –or so it claims Brooke Magnanti, invoking the intellectual authority of Stalin. This book has indeed a quality of its own: accuracy. Our folk understanding of sex is full of made up numbers to which we inadvertently stick without further reflection. Checking them out is more complicated that it seems: there are competing sources and we need a certain degree of statistical (and methodological) literacy to assess them properly. Hence, we can only be grateful to have Spiegelhalter, a world-leading statistician, spelling out for us what we really know about the numbers of sex in a clear and accessible manner.

Spiegelhalter is a Bayesian: for him, probabilities measure how strong our beliefs about random events are. This is a technicality that readers may safely ignore, but it explains why the book starts with a credibility ranking of the available figures about sex: numbers we can believe, numbers that are reasonably accurate, numbers that could be out by quite a long way, numbers that are unreliable, and numbers that have just been made up. Evidence in the two first categories will improve our statistical understanding of sex, whereas the remaining three scores will probably mislead us.

Ranking evidence depends crucially on its sources and half of this book is about how social research on sexuality can be properly carried out. Spiegelhalter's paradigm for reliable data is the British National Survey of Sexual Attitudes and Lifestyles (Natsal-3, 2010-2012). This is based on a random sample of face-to-face interviews funded by a private charity, the Wellcome trust -incidentally, the same trust commissioning this book. Spigelhalter spends time discussing the methodology and comparative reliability of his many sources (devoting an entire appendix to Natsal methods) and the crucial choices on which they all depend (e.g., what counts as a sexual partner). He also uses Natsal data in the first few chapters to introduce a number of handy statistical concepts: the mean and the median are important when we wonder about how much sex we are having.

With all these methodological caveats in sight, Spiegelhalter proceeds to inform you about everything you thought you knew about sex, despite not having a reliable source to check. Statistics about partners, heterosexual and homosexual activity, masturbation, reproduction etc. Most of it illustrated with graphics, about which I will make my only formal complaint about the book: in the epub version, sometimes they were not easy to read (despite trying the graphics on various readers). The text instead is delightful to read. Spigelhalter excels at both clarity and wit, both in the best British tradition, even if (or perhaps because) the topic is sex. 

Spigelhalter is cautious, but not shy, in appraising causality through data. Sometimes the evidence makes more likely some explanations of why sex happens the way it does. But often the data are far from conclusive regarding causation and, at best, they just describe what we do (and how often we do it).  Spiegelhalter adopts a good old positivist stance regarding the science of sex and admits at all points what we do not know, keeping it separate from any normative judgment. The most opinionated readers may be displeased by such a sober discourse on sex. The rest of us will be surely enlightened by the quality in the quantity.

{August, 2016}
{Metapsychology}

Paul Erickson, Judy L. Klein, Lorraine Daston, Rebecca Lemov, Thomas Sturm, Michael D. Gordin, How Reason Almost Lost Its Mind. The Strange Career of Cold War Rationality, Chicago (Ill.), University of Chicago Press, 2013

Is rationality as clean and well-defined concept, such as a system of axioms, or rather a sticky syrup, like a “bowl of molasses”? Philosophers, at least within the analytic tradition, usually opt for axiomatic definitions and a paradigmatic illustration is, for instance, expected utility theory (EUT). Established by von Neumann and Morgenstern in 1947, and expanded later by Savage in 1954, it quickly became the paradigm for the analysis of decisions between uncertain alternatives, until the accumulation of experimental anomalies forced economists to search for alternatives –although none has completely displaced it, as of today. The normative appeal of EUT (as a warrant of consistency in our decisions) still captivates philosophers, but all this anomalies have forced us to rethink whether there is some axiomatic unity in our rational choices or whether our decisions are like molasses and EUT is just one bowl containing some.

Herbert Simon made the remark about the bowl of molasses commenting on how “the irrational is the boundary of the rational” (115). As I read it, How reason almost lost its mind(CWR from now on) is a book about such boundaries: the concepts that came to define rationality among the social scientists around the 1950s and 1960s would not have hold together were it not for the context (the bowl) provided by the Cold War.

The ideal type of Cold War Rationality (3-4) would be a formal algorithm providing mechanically the best solution for a given problem. These algorithms would originate in the analytical decomposition of the actions of a person of “seasoned experience and proven judgment” (43), so that anyone could implement such sets of rules and obtain the same success. Human calculators, computing variables for astronomers in many 19^th and 20^th century observatories, provide a paradigm of the rationality that Cold War would generalize, thanks mostly to the success of algorithms in foundational research on the paradoxes of set theory. Ideas then flew from the more abstract regions of mathematics to the social sciences, in a process accelerated by the II World War and its posterity.

One major issue in the historiography of rational choice theory is to what extent it was shaped by such context: for instance, is it something more than a formal rendition of the neoliberal ideology that emerged after the war? In this case, we may wonder whether the rules defining rationality were somehow tainted by their military uses. The answer of CWR seems mostly negative. For a start, Cold War Rationality is something more than a simple combination of decision and game theory. Bounded rationality was just as much a Cold War product. The organization of the airlift that would provide basic supplies to Berlin during the Soviet blockade started a research agenda on military management that ultimately led Herbert Simon to defend the necessity of non-optimizing decision rules. The limitations of information and computing power that plagued such projects left no alternative.

Even further from rational choice standards, but equally part of Cold War rationality was Charles Osgood’s GRIT, the acronym for “graduated and reciprocated initiatives for tension reduction”. Osgood, a psychologist, studied strategies for de-escalating conflicts –paradigmatically, in the nuclear arms race. Osgood did not establish his decision rules on formal grounds and, as CWR point out, they were difficult to test experimentally. But nonetheless they had the algorithmic form distinctive of the era. And there is even more to Cold War rationality. Rules did not only emerge in theoretical contexts as a solution to a given problem, be it formal or not. There was also empirical research on how rules emerged, via the analysis of “situations”. These were small group interactions placed in a context that could be externally controlled and observed: e.g., a negotiation in a room with microphones and one-way mirrors, as the one used by Robert Bales at the Harvard Laboratory of Social Relations in the 1950s. Decomposing the interaction into its minimal elements and coding how often they featured would allow social scientists to engineer future exchanges so that they yielded the desired outcomes.

If Cold War rationality is so diverse (and showing it is a major contribution of this book), we may well grant that its content was not constrained by one single agenda. But then what brings all these different algorithms together under the umbrella of rationality? The bowl containing this molasses would have been the military demand for procedures that could handle the complexity of Cold War issues –from nuclear strategies to logistics and negotiation processes. Military budgets funded research according to their needs, independently of any disciplinary boundary. The RAND Corporation was probably the most successful hotbed of Cold War rationality, but we can find research programs tied to the military in University departments all over the United States.

According to CWR, the threat of a nuclear conflictwas powerful enough to break through the different paradigms then available for the study of decision making and bring them into a real debate. Had it not been for the Cold War, the topic might have been studied along more conventional disciplinary paths, with a different level of mutual engagement.Just as it happened after the end of the Cold War. When the bowl of military demand cracked, the molasses of rationality spilled in a plethora of experiments that showed a plurality of decision rules at work (namely, heuristics and biases), more or less deviant regarding formal standards of rational choice.

CWR shows, in sum, that Cold War rationality was more diverse than rational choice theory and that the one in the many, bringing together all such diversity, was the nuclear threat providing the context. Both points are carefully argued and I have learnt a great deal with this volume. But, of course, it is my task to challenge them –trying to live up, I hope, to the spirit of those foundational Cold War debates.

Starting with diversity, the authors define their ideal type in the most encompassing manner, but they often argue as if the canon within Cold War rationality was rational choice theory. I don’t think, at least, that any other of the approaches discussed in the book exhibits to the same degree the features of the type listed in p.5: formal methods modelling self-interested individuals in conflict, with a radical simplification of the circumstances and a step-by-step impersonal approach to a solution. As the authors acknowledge (p. 94), GRIT rulesfor conflict resolution are not as algorithmic as the identification of Nash equilibria. Even if the setting put individuals in conflict, situation rooms apparently neither sought nor yieldeddecision rules (p. 124). And certainly “the collapse of Cold War rationality” came with experimental tests of rational choice models. The other research agendas sparked by the nuclear threat apparently did not make it that far: whereas Cold War results in, e.g., game theory are still part of the standard curriculum in some social sciences, most other topics addressed in this book only belong in the history of their disciplines.

Why not telling the story of Cold War rationality, in all its diversity, giving its weight to its difference constituents? At this point it wouldn’t seem Whiggish, just an acknowledgment of the longer reach of rational choice theory among Cold War theories. My impression is that the authors do not seem very inclined to make such distinction, because they implicitly disagree with the sort of social science associated with rational choice theory (e.g., “the notoriously mean and lean Homo economicus”, p. 185), and they treat it as if its time was already past. This is how I make sense, at least, of the title of the book: “How Reason Almost Lost its Mind”. The reduction of rationality to formal decision models seems was often achieved “at the expense of reason” (p.2), where this latter is understood as the sort of Enlightened wisdom that an automaton can just poorly imitate. The “almost” in the title seems to suggest that the Cold War is over and there is a chance for reason to regain its grounds. Thereby, perhaps, the surprise at philosophers still spending so much time on rational choice theory as of today (p. 187). But what are the reasonable alternatives that we should be discussing instead?

I would have expected though that a historical analysis of Cold War rationality would have made explicit instances of such alternatives at the point where they were perhaps considered and discarded. Taking up again, by way of instance, EUT, it might have been more fruitfulto discuss how a reasonable decision rule from the Enlightement(Bernoullian utility functions) became the standard of Cold War decision making? After all, choosing between uncertain alternatives according to an average (expected utility maximization) is just an option among others (why not focusing on the variance). What made it so attractivecirca 1940?Can we explain its normative appeal on a priori considerations (such as Savage’s Dutch Book argument) or is it also ideological?After all, the alternatives to EUT now under construction among decision theorists (prospect theory, etc.) are closer to Cold War rationality standards than to any sort of mindful reason. And this was the case already in the 1950s: think of Allais’ arguments about the reasonability of EUT. So what is the reason beyond rationality in CWR?

Alternatively, we may wonder whether the Cold War is really over, as far as the idea of rationality in the social sciences is concerned. The contextual pressure of a nuclear threat may have propelled the deployment of rational choice theory in the social sciences. But probably something else is keeping it in place now, for the right or the wrong reasons.Reading CWR I cannot understand well why such algorithmic standards of rationality still prevail. The answer might not be epistemic at all: since the American military and the policy makers were mostly alone on the demand side for rationality during the Cold War, I can’t help wondering whether they were satisfied with the outcome they funded so generously. Perhaps the survival of Cold War Rationality is, after all, the survival of the intellectual institutions that won such War. Historians are certainly among the few who can answer that.

{September, 2014}

{History of the Human sciences, 2017}

Franklin G. Miller, Luana Colloca, Robert A. Crouch, Ted J. Kaptchuk, The Placebo: A Reader, Baltimore, Johns Hopkins University Press, 2013

The "reader" genre is becoming more difficult today than in any previous decade: in the pre-digital repositories age, compilations granted easy access in print to papers, otherwise difficult and expensive to obtain. Nowadays, we will only buy such compilations if they combine an excellence of editorial taste and readability that beats the temptation of downloading our own selection directly from a journal archive.  In this regard, I must admit that the editors of this placebo reader have succeeded in producing a volume worth buying. 
  

The book compiles 52 papers on the placebo effect divided in four sections. Eight articles feature in the first one, on the concept and significance of the placebo effect. 30 more are classified under four headings in the second section, experimental studies of the placebo effect: the headings are pioneering efforts, psychological mechanisms neurobiological mechanisms and contextual factors. The third and final section, on the ethics of using placebos, presents the last 14 papers about research and clinical practice. The papers are chosen and presented in such a way that the compilation reads as a historically motivated introduction to our current understanding of the placebo effects.

The uninitiated reader will probably appraise the placebo as a treatment without active ingredient that nonetheless makes (some) patients improve (e.g., sugar pills). As Ted Kaptchuk observes in his introduction, this is a relatively modern concept. Using placebos implies that we are somehow able to differentiate between effective and ineffective treatments and such a distinction could only be properly quantified with the emergence of clinical trials in the 1940s. There was an initial enthusiasm about the healing power of placebos that gradually vanished with more sophisticated analyses (documented in the anthology with papers from the 1980s and 1990s): the statistical data of most clinically relevant variables tend to regress from extreme values (disease) to the mean (health) of their distribution, and we can only take properly into account this spontaneous improvement if we compare in a trial a group of patients treated with a placebo with another one with no treatment at all. Taking all this into account, the mainstream view today is that the only placebo effect statistically documented appears when measuring patient reported outcomes, such as pain. The papers complied in the first section document how this view emerges.   

It is worth recalling here that clinical trials were introduced in medicine as a yardstick for assessing the effective of treatments without a real causal understanding of why they were effective. E.g., the underlying mechanism of the antidepressant action of benzodiazepines was understood in the 1970s almost two decades after the first trials, when Valium was already one of the best selling drugs of the past century. Trials often guided our investigation of such mechanisms, showing how a drug operated under a range of different circumstances. In this respect, placebos would be like any other treatment: we lack a "robust and comprehensive" (Kaptchuk) theory, but there is a growing body of experiments documenting how placebos work. First, there are psychological mechanisms, among which the most prominent are behavioral conditioning (often unconscious) and expectations (usually conscious) induced verbally or, e.g., through social observation. Through a number of experimental designs we learn how these mechanisms operate and the physiological responses they trigger (e.g., the release of opioids). Then there are neurobiological mechanisms underlying placebo, illustrated in a number of experiments supported by various forms of brain imaging. Finally, there are contextual factors, often related to the interaction between physicians and patients in a given setting. 

Half of the third section, on the ethics of placebo, hinges on clinical trials as well. Here the approach is mostly methodological: to what extent do we actually need placebo in order to ground solid experimental designs? More precisely, do placebos provide a real benchmark to gauge the efficacy of a new treatment? The obvious ethical implication is that, were the response negative, there would be no reason to use a placebo instead of an active treatment (if there was one) as a comparison. Moreover, since placebos partly operate through the patients' expectations, it is an open question how much shall we deceive them about the (lack of) treatment they are receiving. There is some evidence about placebos working when they are almost openly presented as such. And there is also evidence, presented in the second half of this section, about physicians prescribing placebos outside trials and a discussion about the ethics of such a practice. 

The book closes with a paper by Miller and Colloca, two of the editors of the volume -there are 10 papers co-authored by, at least, one of the members of the editorial team, so there is no pretence of neutrality in the compilation. Their conclusion summarizes somehow the agenda this volume seems to promote: for certain conditions, placebo might actually be an effective treatment; if there is evidence gathered in well-designed trials and the nature of the treatment is properly disclose to the patient, it is acceptable to prescribe it. Hence, acupuncture for pain relief in various conditions could be legitimately prescribed on evidence-based grounds. But, for the time being, no other placebo meets such a scientific standard. 

On a more general note, I'd say that a major thread in this book is that it contributes evidence to ground quite a paradoxical intuition: the mere act of diagnosing a patient and administering a treatment (at least for a few conditions) has effects that break the equivalence between "placebo" and "lack of treatment". My favorite illustration in the book is an trial with Kaptchuk as first author (pp. 226-32) testing different "treatments" for the irritable bowel syndrome: being in a waiting list (measuring patients' response to observation and assessment); sham and real acupuncture (placebo) and an augmented placebo: the needling was accompanied by a scripted positive interaction with the physician. The trial showed that these three components add up progressively, reaching a maximum effect with the augmented placebo, reaching a clinically significant effect in the treatment of the condition. 

In the traditional approach to trials, the preferences of patients were considered a source of bias, since they could make a difference on the outcome. The evidence gathered in placebo research shows that, except for pain, there is no trace, so far, of a significant effect of the patients’ expectations on the treatment outcome. Perhaps this volume should prompt us to reconsider the status of blinding as a debiasing method: its usual justification is precisely that it controls for placebo effects derived from the patients preferences about treatments. Making them entirely alike breaks any systematic correlation between such preferences and the treatment outcome. But if there is no placebo effect for most conditions, perhaps we should reappraise blinding as a method to enforce the treatment protocol: since some patients would drop off the trial if they knew they were receiving an unwanted treatment, blinding secures their compliance, independently of the placebo effect. Clinical trials are indeed strategic interactions between agents with different, sometimes conflicting, interests that we should take into account in designing the trial. Controlling for some of these interactions (more than the placebo effect) might be the real justification of masking devices. In one of the compiled papers, R. Temple and S. Ellenberg contribute another argument in this same vein against active-control equivalence trials (p. 258): if you compare a drug against placebo, you have every incentive to enforce compliance with the trial protocol, since every deviation will usually reduce the differences between treatment groups, making your drug equivalent to a placebo. If you make a comparison with a standard treatment in order to prove lack of difference, there are weaker incentives to enforce protocol compliance. In other words, placebos may play a role in making both patients and researchers alike play by the rules of the experiment.

Two final positive comments. One surprising feature of this collection is how well it reads: each section is preceded by a short (but incisive) introduction intended as a road map of the papers to come. These are short and clear, and very accessible for the lay reader. The design of the experiments, their findings and the issues they raise are often so puzzling that the collection becomes engaging: I found myself eager to know whether an experiment had passed the test of replication, whether counter-arguments existed, if there was a final word on a topic. The papers are selected and ordered in such a way as to elicit this sort of engagement. Another surprising trait is the size of the volume (10.9 x 8.4 x 0.9 inches): it may initially look difficult to handle (in this age of palm-sized readers), but I found it very pleasant to work with.

{January 2014}

{Metapsychology online reviews}

Raffaella Campaner, Philosophy of medicine. Causality, Evidence and Explanation, Bologna, Archetipo Libri, 2012

For more than a decade now, there has been a growing interest in the philosophy of medicine as a scientific discipline. Already in 2005, Raffaella Campaner published a monograph in Italian on causality and explanation in medicine (Spigazione e cause in medicina: un’indagine epistemologica) showing how philosophy of science could be successfully applied to biomedical research. Throughout this decade, Campaner published a series of papers in English on the same topics that are now compiled in the reviewed volume. Most of these papers were originally published in edited collections or journals where medicine was not the central topic, so re-publishing all together in a single volume makes sense for the interested reader. Moreover, the Italian publisher has produced a decently edited but inexpensive book, so all in all philosophers of medicine should welcome it.

Campaner has gathered here 9 papers plus an introduction. Their structure is somewhat similar: the author presents different philosophical positions (mostly on causality, but also on explanation) and proceeds to illuminate them with medical case studies, arguing on this basis for her own claims. The reader will find thus an introduction to the following accounts on causality: mechanistic (Salmon, Machamer-Darden-Craven, Glennan), interventionist (Woodward) and manipulative (Price and Menzies), with a brief digression on counterfactuals (Lewis). Despite featuring on equal rank in the book’s title, we do not find introductory accounts of philosophical theories of explanation and evidence. Campaner considers instead plenty of medical explanations and evidences and see how they may fit in the different philosophical accounts of causality presented. Among her case studies, two of the most detailed are on deep brain stimulation (a therapy for Parkinson’s disease) and anti-AIDS treatments. Campaner deals also in several papers with epidemiological and psychiatric causation.

The book puts forward a pluralistic perspective on causation, showing how in actual medical practice we may find all the above mentioned approaches complementing (rather than competing with) each other. The choice often depends on the methods implemented and the context of implementation. The author does not try to construct a principled argument for causal pluralism: as she acknowledges, “lots of work is still to be done before a plausible and coherent view will be settled on and shared” (p.60). The strength of her argument is empirical: there is no evidence that a “one size fits all” concept of causation can cope with the diversity of causal approaches at work in medical practice. However, Campaner also draws on a conceptual insight emerging from this diversity: diseases would be multilevel phenomena (ranging from cells, molecules, tissues upwards to the whole organism) and medicine (siding here with Schaffner, p. 11) would be a set of middle-range theories coping with them. Campaner adopts here a sort of meta-philosophical instrumentalism regarding such deeply entrenched methodological divides such as the one opposing reductionism and anti-reductionism: as she illustrates in chapter 7, both strategies have been fruitful in medicine and both might make sense contextually. In this respect, I think is worth noticing how difficult it is to sustain even moderately pluralist stances about medical causality such as the Russo-Williamson thesis –according to which we would need mechanistic and probabilistic evidence to properly ground causal discoveries. Yet, as Campaner argues in chapter 2, medicine has been quite capable of making progress without mechanisms and yet, when we have them, we often need manipulative evidence, in addition to statistics, to properly ground them.

Campaner constantly reminds us that her pluralism does not “amount to treat all available methodological options as equal in value” (e.g., p. 133), but the book focuses mostly on cases where there is more complementarity than straightforward competition between the alternatives considered and all of them are worth, at this point in time, of scientific consideration. Historically, though, medicine has not been as peaceful as it might seem today. In The Rise of Causal Concepts of Disease (2003), for instance, K. Codell Carter has forcefully argued that scientific medicine began with the adoption of the etiological standpoint, the view that every disease has a single cause which is both necessary and sufficient for the disease, showing how this approach was crucial for progress in its treatment. Even today, I would say that medicine is not really pluralist when it comes to decision making about new therapies: we still rely on their success in randomized clinical trials as a rule. Of course, trials might be interpreted from different causal stances, but not all of them are equally captured in their design: mechanistic knowledge, for instance, does not currently qualify the value of a trial in most hierarchies of medical evidence.  In other words, as of today, philosophical pluralism about causation may faithfully reflects the way medicine is practiced, and methodological diversity may be in itself a fruitful research strategy. But I think Campaner’s claim would have been more balanced if it also considered cases in which there was open disagreement about causality between competing research agendas.

My major qualm with this volume is that the papers were not edited for the compilation. Reading it from cover to cover might be a bit reiterative sometimes since the same items are often revisited in different chapters. However, it makes it really suitable for use in undergraduate courses, in particular when teaching philosophy of science to medical students, since most concepts are explained in an accessible manner detail and illustrated with theories they will be certainly familiar with. The name index at the end is particularly helpful in tracing different approaches throughout the book and keeping the original abstracts at the beginning of each chapter is equally useful to guide the uninitiated reader. Campaner’s is thus not only a good philosophy of science in practice book, but also a very accessible book in itself.

{October 2013}

{International Studies in the Philosophy of Science 27.4 (2013), 456-458}