Marco Buzzoni

The often-emphasized tension between the singularity of the patient and technical–scientific reproducibility in medicine cannot be resolved without a discussion of the epistemological and methodological status of the human sciences. On the one hand, the rules concerning human action are analogous to the scientific laws of nature. They are de facto sufficiently stable to allow predictions and explanations similar to those of experimental sciences. From this point of view, it is only a trivial truth, but still a methodological irrelevancy, that the patient and the doctor–patient relationship represent an ontologically irreproducible reality. On the other hand, however, one can never exclude that one can fail in the application of "laws" of the human sciences to the individual patient, for such laws are by no means wholly separated from a patient's personal-hermeneutic mediation, and can at any time be revoked by becoming aware of them. This requires a synergistic collaboration of clinical and statistical methods, and shows a methodologically relevant sense in which one cannot disregard the singularity of the patient. The reason for the crucial role of the patient's singularity in medicine is every individual patient's capacity to revoke, in principle, routines and quasi-automatisms, even though the personal mediation by the patient's consciousness de facto changes them in such a small degree that predictions and explanations modeled in experimental science remain possible.

All the powerful influences exertedby the subjective-interpersonal dimension onthe organic or technical-functional dimensionof sickness and health do not make anintersubjective test concerning medicaltherapeutic results impossible. Theseinfluences are not arbitrary; on the contrary,they obey laws that are de facto sufficientlystable to allow predictions and explanationssimilar to those of experimental sciences.While, in this respect, the rules concerninghuman action are analogous to the scientificlaws of nature, they can at any time be revokedby becoming aware of them. Law-like andreproducible regularities in the sciences ofman are by no means separated from a patient'spersonal-hermeneutic mediation. This makes itpossible for human beings to modify, improve orsometimes even entirely (or better almostentirely) suspend these psychological,sociological, ethnological, medical,regularities. For this reason the sciences ofman including medicine are under the obligationof constantly inspecting the continuingvalidity of the rules on which theirpredictions and explanations are based, namelyby indirect, statistical methods. Thisrequires a synergistic collaboration ofextra-clinical and clinical tests through whichmedicine can obtain a good level ofintersubjective testability.

On the relation between experiment and thought experiment in the natural sciences. To understand the reciprocal autonomy and complementarity of thought and real experiment, it is necessary to distinguish between a ‘positive’ (empirical or formal) and a transcendental perspective. Empirically and formally, real and thought experiments are indistinguishable. However, from a reflexive-transcendental viewpoint thought experiment is at the same time irreducible and complementary to real experiment. This is due to the fact that the hypothetical-anticipatory moment is in principle irreducible to physical reality—even though it refers to physical reality and is bound with the empirical use of our understanding. The presence of counterfactuals is the condition of the possibility for thought experiments to become in principle real ones, by means of a series of technical realisations that gradually approximate the idealisations that they contain.

The terms “perspectivism” and “perspectivalism” have been the focus of an intense philosophical discussion with important repercussions for the debate about the role of mechanisms in scientific explanations. However, leading exponents of the new mechanistic philosophy have conceded more than was necessary to the radically subjectivistic perspectivalism, and fell into the opposite error, by retaining not negligible residues of objectivistic views about mechanisms. In order to remove this vacillation between the subjective-cultural and the objective-natural sides of mechanisms, we shall raise the question about theory-ladenness over again and interpret it in its connection with the technical–experimental nature of scientific knowledge, as affirming the perspectival character of scientific knowledge: It is because of the character at once theory-laden and practice-laden, i.e. technique-laden, of our putting questions to nature that empirical reality must be investigated from particular perspectives: nature can be known scientifically only from a potentially infinite number of perspectives or theoretical points of view, concretely exemplified by mechanisms or experimental ‘machines’ that allow specific access to specific aspects of sensible reality.

All the most important epistemological and ontological theses of Kuhn's theory of science depend to a decisive extent on corresponding ideas of Wittgenstein's theory of meaning. The semantic and ontological assumptions that determine the main trend of Kuhn's epistemology consist, respectively, of a theory of meaning as use or application of empirical terms to nature and an ontology that conceives the real as a continuous essentially amorphous and undifferentiated, in which only language and its rules can insert order and regularity, In Kuhn's theory of science, however, beside this main trend of thought, there is another one, by far secondary, which moves towards a realistic conception of scientific theories, although it usually stops halfway, assuming the aspect of an unsustainable and unoriginal indirect realism. After highlighting the oscillations and internal difficulties not only of Kuhn's epistemology and methodology, but also of the Wittgensteinian theory of meaning, the final part of the volume outlines a realistic conception of scientific knowledge that takes as its foundation the intrinsically cognitive nature of instrumental operations and tries to provide a satisfactory response to Kuhn's challenge and, in particular, to his thesis of incommensurability. From this point of view, the use and reference of scientific terms or theories are constitutive and inseparable moments of their meaning, and refer to an internally structured relational reality.