The symposium “Philosophy of Pharmacology: Theoretical Foundations, Methodological Evolution, and Public Health Policy” took place at LMU Munich on 22 August, 2017, as part of the Ninth Congress of Analytic Philosophy (ECAP9) of the European Society of Analytic Philosophy (ESAP). The congress was jointly organized by Barbara Osimani, Jürgen Landes, and Roland Poellinger. The program featured contributions by four speakers:
- Barbara Osimani (Ancona / LMU)
- Rani Lill Anjum (Norwegian University)
- Elena Rocca (Norwegian University)
- Ralph Edwards (Uppsala Monitoring Centre of the World Health Organization)
At the overlap of philosophy and health science, this symposium offered a panorama of the complex network of interests found in pharmacology (financial, reputational etc.) as well as the scientific and social ecosystem in which pharmacology is embedded. A special focus was on current debates regarding 1) standards for evidence evaluation, 2) methodological evolution, and 3) pragmatics as well as epistemic asymmetry of causal assessment of risk vs. benefits.
Barbara Osimani opened the symposium with an overview of competing paradigms for medical inference and the roots of their dissent: Evidence Based Medicine grounded in frequentist statistics attaching a stronger emphasis on the reliability of the measuring instrument (internal validity), and critics of such paradigm such as Nancy Cartwright, Jon Worrall, and the EBM+ group, laying a higher importance on issues of external validity and acknowledging the importance of different types of evidence as a complement to RCTs. She showed how formal epistemology can serve as a lingua franca in which these issues can be discussed and investigated (Landes, Osimani, Poellinger, 2017; Landes, Osimani, forthcoming).
Rani Lill Anjum expounded a dispositionalist view on causation in medicine which entails that causation in medicine is tendential, intrinsic, complex and context-sensitive. She pointed out that ineffective treatment as well as adverse reactions offer an opportunity to investigate the local context with the aim of uncovering more details of the causal mechanism of the drug. Thalidomide, valproic acid and Zolpidem served as illustrative cases (Anjum et al. 2015; Mumfurd and Anjum, 2011).
Elena Rocca‘s talk focussed on the importance on reporting cases of unexpected drug effects. This not only helps with assessing the frequency and severity of adverse drug reactions but it may also reveal, so-far, unsuspected mechanisms in the human body. Knowledge of such mechanisms may trigger the development of new drugs, but it can also be instrumental for the development of tests which reveal whether a mechanism required for an adverse reaction is operational in a patient (Rocca, 2017).
Ralph Edwards hammered home the scale of problem, annually, hundreds of thousands of people lose their lives; adverse drug reactions continue to be one of the leading causes of death in developed countries. He then spoke about how the World Health Organization’s Uppsala Monitoring Centre analyses reports of suspected adverse reactions. The human papillomavirus (HPV) served as a case study highlighting technical and also ethical challenges in pharmacovigilance (Caster, 2017 and Edwards, 2012 ).
Rani Lill Anjum, Samantha Copeland, Stephen Mumford and Elena Rocca. CauseHealth: integrating philosophical perspectives into person centered healthcare. 2015. 3(4): 427-430 European Journal for Person Centered Healthcare.
Ola Caster, Lovisa Sandberg, Tomas Bergvall, Sarah Watson and G. Niklas Norén. vigiRank for statistical signal detection in pharmacovigilance: First results from prospective real-world use. 2017. 26(8):1006-1010 Pharmacoepidemiology and Drug Safety. Doi: 10.1002/pds.4247
I. Ralph Edwards. Good pharmacovigilance practice and the curate’s egg. 2012. 35(6):429-435 Drug Safety. Doi: 10.2165/11634410-000000000-00000.
Jürgen Landes, Barbara Osimani and Roland Poellinger. Epistemology of Causal Inference in Pharmacology. European Journal for Philosophy of Science, 2017. URL Doi: 10.1007/s13194-017-0169-1. 47 pages.
Jürgen Landes and Barbara Osimani. Exact replication or varied evidence? The Varied of Evidence Thesis and its methodological implication in medical research. 2017. 59 pages, under review.
Stephen Mumford and Rani Lill Anjum. Getting Causes from Powers. 2011. Oxford University Press.
Elena Rocca. Bridging the boundaries between scientists and clinicians — mechanistic hypotheses and patient stories in risk assessment of drugs. 2017. 23(1):114-120 Journal of Evaluation in Clinical Practice. Doi: 10.1111/jep.12622.