Do medical schools teach medical humanities? Review of curricula in the United States, Canada and the United Kingdom.

RATIONALE AND OBJECTIVES: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. METHODS: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. RESULTS: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. CONCLUSIONS: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited.

Manipulative evidence and medical interventions: some qualifications.

The notion of causal evidence in medicine has been the subject of wide philosophical debate in recent years. The notion of evidence has been discussed mostly in connection with Evidence Based Medicine and, more in general, with the assessment of causal nexus in medical, and especially research contexts. "Manipulative evidence" is one of the notions of causal evidence that has stimulated much debate. It has been defined in slightly different ways, attributed different relevance, and recently placed at the core of Gillies' "action-related theory of causality", a view specifically meant to address causation in medicine. While in general sympathetic to Gillies' account, and totally convinced of the relevance of manipulative evidence and different sorts of interventions in the biomedical sciences, we believe that some further qualifications are needed to allow the notion of manipulative evidence to better express features of medical practice. In particular, we provide some qualification of the role of "interventional evidence" proposed by Gillies, suggesting a distinction between "interventional evidence" and "evidence for interventions". A case study from research on rare diseases is analyzed in depth and a multifaceted notion of manipulative evidence put forward that allows better understanding of what manipulations in medical contexts amount to and what their targets are.

Scientific Practice in Modeling Diseases: Stances from Cancer Research and Neuropsychiatry.

In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test-support or criticize-the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on cancer research and neuropsychiatry. It jointly considers fields, which are usually dealt with separately, and keeps a close eye on scientific practice. The article has a twofold aim. First, it shows that identification of the explananda is a key issue when looking at dynamic processes and their implications in medical research and clinical practice. Second, it discusses the relevance of organizational accounts of mechanisms, and questions whether thorough self-sustaining mechanistic explanations can actually be provided when addressing cancer and psychiatric diseases. While acknowledging the merits of the wide ongoing debate on mechanistic models, the article challenges the mechanistic approach to explanation by discussing, in particular, explanatory and conceptual terms in the light of stances from medical cases.

Why include the humanities in medical studies?

The relation between philosophy and biomedicine has been reassessed and rethought in the last few years: on the one hand, philosophy of science has paid increasing attention to actual modes of biomedical research and clinical practice; on the other, classes in philosophy, and more generally, in the humanities, have started entering medical curricula. However, the role of philosophy in medical education is not yet unanimously recognized, with situations differing significantly in various national and international contexts. In line with the tradition in Italy and other countries of reflecting on clinical methodology and with the recent initiatives at the crossroads between medicine and philosophy, this contribution aims to argue for the mutual relevance of medicine and philosophy in educational processes, and to suggest some possible forms of implementation of their interactions.

Mechanistic causality and counterfactual-manipulative causality: recent insights from philosophy of science.

Current epidemiological and statistical theory about research methods and how to elicit causation from epidemiological studies is strongly influenced by counterfactual-manipulative thinking. However, thinking about how disease states develop is rooted in mechanistic 'webs of causes'. After a tremendous growth of research in molecular biology, biochemistry and genetics, attention has increasingly been paid to environmental and socioeconomic factors as determinants of diseases. This led to conceiving of most pathologies as caused by multilevel mechanical systems. The nature of 'mechanisms' has been the subject of extensive philosophical reflection over the past couple of decades. The present paper will first present some of today's philosophical insights in what are called biologic or other 'mechanisms' and thereafter show how these concepts can be linked to counterfactual-manipulative views.

Understanding mechanisms in the health sciences.

This article focuses on the assessment of mechanistic relations with specific attention to medicine, where mechanistic models are widely employed. I first survey recent contributions in the philosophical literature on mechanistic causation, and then take issue with Federica Russo and Jon Williamson's thesis that two types of evidence, probabilistic and mechanistic, are at stake in the health sciences. I argue instead that a distinction should be drawn between previously acquired knowledge of mechanisms and yet-to-be-discovered knowledge of mechanisms and that both probabilistic evidence and manipulation are essential with respect to newly discovered mechanisms.

[Philosophical theories of causation for epidemiology]. / Teorie filosofiche della causalità per l'epidemiologia.

What is a causal nexus? How do we get to know one? In the last decades a proliferation of philosophical theories, mainly put forward as opposing each other and as possible alternatives, has been trying to answer such questions. In the last few years the need has been emerging to refer any analysis of the concept of cause to the context in which it is adopted. The pursuit of a single definition has been thus substituted by the elaboration of various forms of causal pluralism, aimed at accounting for the actual use of the notion of cause especially within some of the so-called <>, such as economy, law, medicine. We shall here outline the main contemporary approaches (probabilistic, mechanistic, counterfactual and manipulative) and some of the intersections they can have with reflections on causation taking place in epidemiology.