Marco Buzzoni

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.

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.