Philosophy of Biomedicine

First published Thu Apr 9, 2020; substantive revision Tue Jul 15, 2025

Despite the simple name, biomedicine is not simply the area of overlap between biology and medicine. It is a framework, a set of philosophical commitments, a global institution woven into Western culture and its power dynamics, and more. Biomedicine is the umbrella theoretical framework for most health science and health technology work done in academic and government settings. Western medical practices and the surrounding healthcare infrastructure are principally biomedical. Health-related corporations are predominantly biomedical in orientation (with the exception of a few homeopathic producers and other scattered outliers). International medical aid mainly offers biomedical resources. Biomedicine, in other words, is the name for how most powerful global institutions envision the relations between biological sciences and medicine.

The biomedical model is in fact so commonplace that it is easy to overlook how philosophically weighty (and contentious) its core commitments are: that health phenomena must be understood in terms of physical/biochemical entities and processes, that experimental techniques are the preferred means of acquiring and assessing health-related knowledge, and that human bodies are best understood as composed of a collection of subsidiary parts and processes (Krieger, 2011, p. 130). In addition to critiquing those core commitments, philosophers have also disputed connected issues regarding the meanings of health and disease, the nature of biomedical knowledge and expertise, the value of reductionist thinking, the value of biomedicine’s global institutions, etc. Some philosophers have also proposed alternative frameworks for understanding the relations between biology and medicine. Though, relatively little literature is directed at biomedicine per se. The fact that the philosophical literature is so critical is in part because 1) biomedicine is so expansive that there is no shortage of flaws to identify, and 2) biomedicine is deeply embedded in the current global order, and hence is tied directly or indirectly to all of the goods and ills of that order.

Biomedicine’s expansiveness includes a set of epistemological commitments as well as a connected set of institutions. Moreover, much philosophical work directly or indirectly critiquing biomedicine leaves it unclear whether suggested improvements are small amendments or whether biomedicine as a whole is destabilized as a result of these weaknesses. Since “medicine” is often used interchangeably with “biomedicine”, it is often difficult to distinguish processes, critiques, arguments, etc. about “biomedicine” from those about “medicine”.

This entry will, as much as possible, avoid duplicating the work done in the thorough Philosophy of Medicine entry. That entry focuses on elucidating the work done by that branch of philosophy, which according to entry authors Reiss and Ankeny, has “dedicated journals and professional organizations, a relatively well-established canon of scholarly literature, and distinctive questions and problems”. Most of the “medicine” examined in “philosophy of biomedicine” is medicine pursued within a biomedicine framework, so there is much overlap. Yet, this entry will accomplish something other than what that entry does. This entry will review the philosophical literature (and some literature in allied fields, such as history of medicine) that scrutinizes the biomedical framework itself, in whole or in part. This chapter will also not provide a detailed history of medicine, including its innumerable social and institutional changes. Readers interested in an overview of the history of medicine to accompany this text can refer to Bynum (2008).

1. Biomedicine as a Framework for Medicine + Biology

Consult with a primary care physician when feeling ill. Perhaps they send you to a medical lab that will take a blood sample to run a biochemical analysis. After the results arrive, consult with a physician specialist whose expertise is the particular bodily organ or system where the ailment is localized. The specialist prescribes a drug that has been mass-produced in a factory, after a biology laboratory extracted the active ingredient from a natural source, or perhaps synthesized it from scratch. The drug’s efficacy has been proven by testing the drug experimentally on two groups with the relevant disease, randomly sorted into an experimental group and a control group so that the drug’s measurable bodily effects could be scrutinized and counted. This is biomedicine. It has quickly grown to be so pervasive around the globe that it is difficult to characterize biomedicine.

1.1 What is biomedicine?

As explored in this entry, and outlined in how the sections are divided in the entry, biomedicine has many facets. It is a very large and complex thing. It is a morphing historical product of the post-World War II West. It is a contemporary global social institution. It is an epistemology of medical research and practice (albeit with factions). It is a set of ontological and metaphysical commitments. And more.

The US National Cancer Institute (NCI Other Internet Resources, accessed 13 March 2025) defines biomedicine as synonymous with “allopathic medicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine”. By contrast, Clarke et al. (2003) take an expansive view of the nature of biomedicine, contending that it is an evolving entity, a cohesive and developing whole that consists of elements ranging from the assertion that good health is a personal moral obligation to the increasing reliance on “computerization and data banking” (A. E. Clarke et al., 2003).

Krieger offers a detailed examination of the history and philosophy of the “biomedicine approach,” and extracts three key epistemological tenets of the view. Among the many features of a biomedical perspective, three stand out as fundamental regarding its approach to investigating disease (Lock & Gordon, 1988; Fee & Krieger, 1993; Krieger, 1994; Lawrence & Weisz, 1998; Cambrosio & Keating, 2001; Bynum, 2008). They are:

First, specific to biomedicine: the domain of disease and its causes is restricted to solely biological, chemical, and physical phenomena; Second, shared with many natural sciences: an emphasis on laboratory research and technology and, as translated to health research, a discounting of research questions that cannot be studied by randomized clinical trials (or their analogs, e.g., “natural experiments”); and Third: an embrace of “reductionism,” a philosophical and methodological stance (discussed more fully below) that holds that phenomena are best explained by the properties of their parts. (Krieger, 2011, p. 130).

Kriger’s account of biomedicine offers a compelling distillation of the epistemological commitments of biomedical science. Though since this is an entry on philosophy of biomedicine, the entry will be organized around philosophical dimensions and debates, rather than being organized directly around these core theoretical tenets (e.g. the upcoming section is on ontological and metaphysical commitments). Additionally, this entry will supplement the tenets identified by Krieger with discussion of connected issues, such as philosophical critiques of biomedicine as a social institution (Section 4). A longer discussion of reductionism is below, in Section 3.4) We use the terms “framework” and “approach” to describe biomedicine, in an attempt to avoid narrowly overcommitting to any particular philosophical system. Biomedicine may or may not qualify as one of Thomas Kuhn’s “paradigms”, in the way that the heliocentric model of the solar system is a paradigm—a complex worldview in which the viewpoints cannot be straightforwardly translated back-and-forth with an alternative paradigm (i.e. if we try to translate the concepts of biomedicine to the pre-biomedical concepts of humoral theory, discussed in Section 1.2 (Kuhn, 1962). Alternatively, biomedicine seems to qualify as one of Imre Lakatos’ Research Programmes, a different way of conceiving of the way that research communities intellectually cohere (Lakatos, 1968). It’s a question of how biomedicine serves as a means of organizing and guiding research. Without getting too lost in the technical criteria, biomedicine shares the Kuhnian paradigm quality of being incommensurable (or at least more or less so) with other conceptions of biology and health. Scholars of complementary medicine have spent enormous effort searching for ways that traditional medical practices—e.g. herbal treatments handed down over generations—can get a foothold in a medical world dominated by biomedicine. It is telling that there is no question that ‘proof’ of a treatment’s efficacy requires starting from scratch, by examining the herb’s chemical makeup, isolating and analyzing which chemical components are the active ingredients, and then testing safety and efficacy, all entirely within biomedicine’s rules. Whatever explanations might have been offered by herbalists (e.g. ‘it calms turmoil in the stomach’) are irrelevant untranslatable knowledge. Biomedicine also shares the Lakatosian Research Programme quality of (largely implicitly) dictating what sorts of internal dispute about biomedicine is permissible. Within the biomedical Research Programme, one is invited to question whether a particular experimental design is suitable; one is not permitted to reject experimentation entirely.

1.2 The history of biomedicine

Biomedicine as a global institution coevolved with its characteristic philosophical positions. While key elements, such as laboratory biology, were present in the 19th century and even before, “World War II is usually presented as a turning point in the ‘biomedicalization’ process” (Löwy, 2011, p. 117). The term “biomedicine” was first used between the two world wars as a shorthand for some of the medical and scientific work being done on radioactive materials (Keating, Cambrosio, & Wilson III, 2003; Löwy, 2011, pp. 49–55). But biomedicine only came into its own during the period of economic and social transformation in industrialized Western countries that followed World War Two:

In industrialized countries, the post-World War II era was also characterized by important increases in public funding for medical research, the extension of health insurance to large parts of the population (a process that, in nearly all the Western countries, the United States excepted, was also supported by the state), and the rapid growth of the pharmaceutical industry. (Löwy 2011: 117)

If biomedicine is a recent historical development, then what exactly came before it? Many different frameworks for health existed before the rise of biomedicine, though many such frameworks exist now despite the dominance of biomedicine. Some have been distinctly influenced by or merged with biomedicine. For instance, osteopathic medicine has gradually gone from a full alternative system of medicine (focusing on manipulation of body via pressure, stretching and other means of readjustment of bodily structure in order to rebalance internal processes), to an alternative track of medical education/practice that has in large part converged with the biomedical/allopathic medicine track (McClain, 2017; Stark, 2013). Insofar as biomedicine formed in the West, it is helpful to see it in contrast to the medical and philosophical traditions that preceded it. That tradition is the Hippocratic tradition—the views attributed to Hippocrates and over two millennia of re-interpretations, riffs, amendments, and other alterations. At the core of Hippocratic medicine were two views. First, it made a commitment to methodological naturalism—a refusal to attribute disease processes to the work of gods and other supernatural beings (Conrad, Neve, Nutton, Porter, & Wear, 1995). Though, it is worth noting that for much of that history, elements of astrology, talismans, and some forms of magic were understood as essentially natural phenomena (e.g., the sun obviously affects health via sunburns and such, so it is not absurd to have inferred that planets could have their own subtle effects on bodies too). Second, it understood health as a matter of balance—and disease as a matter of imbalance—of the humors. Humoral theory was interpreted in many different ways, but centered on the idea that health and disease are attributable to the interactions of anatomical humors (blood, phlegm, yellow bile, and black bile), which were in turn directly tied to a much larger cosmology of the elements (e.g. blood is linked to air, the springtime, a combination of heat and moisture, the heart, and the astrological influence of the planet Jupiter) (Conrad et al., 1995).

The humoral framework remained dominant until emerging scientific approaches began challenging its foundations—a shift that would eventually lead to what we now recognize as biomedicine. However, the actual impact of this biomedical framework has become a subject of intense debate. Thomas McKeown was an influential critic of the biomedical institution (including the work done during its early twentieth century prehistory), having authored the blockbuster volume The Role of Medicine: Dream, Mirage, or Nemesis (1976). McKeown reevaluated the historical record and available evidence to instead hypothesize that the social and economic changes in the West that improved public health conditions were more responsible for population health improvements than biomedicine’s growth. Put bluntly, he argued that twentieth century modernity (economic development, improved nutrition, etc.) caused populations in the West to get healthier over time, then modernity went on to also cause the growth of contemporary medicine/biomedicine, but the medical advances themselves played a generally secondary role in supporting the health improvements. His work has inspired decades worth of debates over the validity of his bold claims, which have been largely overturned or largely vindicated, depending on whom one asks (Link & Phelan 2002).

There is long-standing debate in health policy over exactly how successful the biomedical model has been over its relatively short historical trajectory. The growth of the biomedical model in Western countries occurred at the same time as other social and economic transformations (industrialization, urbanization, globalization, etc.) and at the same time as improvements in life expectancy and a large number of disease outcomes. The ‘received view’ of these historical relations is that social and economic changes allowed the growth of biomedicine, which in turn created new institutions, professional health care practices, and technologies that, in turn, caused vast improvements in health outcomes for the populations served by biomedical institutions. Penicillin is the go-to example for illustrating the positive health impacts of biomedicine (Löwy, 2011). It is a medicine extracted from nature (mold), made into a widely available ‘magic bullet’ thanks to biomedical techniques of identifying its active components, and manufacturing controlled doses of it at reasonable cost at massive scale. Suffering and death from bacterial infections were rapidly alleviated; once hopeless diseases were suddenly curable with a few benign pills.

2. Ontological and Metaphysical Commitments in Biomedicine

Biomedicine is built around a conception of disease as a dysfunction of particular physical parts (organs, tissues, cells) of the body. Despite being hegemonic in the global research community, biomedicine’s ontological and metaphysical commitments are not self-evident, historically long-lived, nor universally embraced.

2.1 Ontology of the body and life in biomedicine

What makes patients and their bodies special? Some philosophers of biomedicine have attempted to make headway in this question by provocatively asking what it means for biomedical sciences to be ‘chauvinist’ and whether this is proper. Biomedical discussions are in large part defined by what they exclude from discussion. Curiously, there are two sides to the coin of biological chauvinism: one that directly supports the biomedical framework and one that challenges it. Both help shed light on the relationship between biology and medicine.

Broadbent (2009) uses the helpful term, “biological chauvinism” to describe the way that biomedicine actively excludes consideration of entities and processes that don’t fit into its worldview: “a refusal to countenance causes of ill health that are not biological” (Broadbent, 2009, p. 305). Biological chauvinists might appeal to ontological or epistemic commitments, e.g., the assumption that knowledge of the body is nothing but knowledge of organic chemical processes, and any processes not clearly reducible to such terms are not yet worthy of being given full consideration. But the strongest case for this chauvinism rests more on pragmatic grounds than on such philosophical assumptions. Biomedicine has built itself into a massive global institution and research enterprise while operating under that assumption (to repeat Krieger’s phrasing from Section 1.1, the assumption is that “the domain of disease and its causes is restricted to solely biological, chemical, and physical phenomena” (Krieger, 2011, p. 130)).

On the other side of the coin, “biochauvanism” is the term applied to the view that there is something philosophically unique about biological organisms—due to their basic nature and/or the limitations of human knowledge’s access to them—that makes them the biological world fundamentally unlike the rest of the world (Wolfe, 2015). Vitalism and phenomenology (see Section 5) are two examples for forms of biochauvinism. Thus there are two rather opposite senses in which we can chauvinistically hold that the biological world is special: 1) a specialness through what life excludes (medicine is nothing but applied biology) or 2) a specialness through what life includes (an intangible vital spirit; a unique frame of time and space). Version (1) of biochauvinism is consistent with biomedicine and version (2) generally is not. The fact that the valorizing of biology can cut both ways helps to show, though, that biomedicine has staked out a sort of middle ground by insisting that understanding health and medicine is accomplished through understanding the innumerable subtleties of biological processes and substances, but that those biological processes and substances must not be so subtle or mysterious as to become untethered from properties and processes condoned by physics and chemistry.

Put another way, the biomedical framework of the body can be understood by considering what it excludes: spirit, vitality, and any other entity or property unknown to mainstream physicists or chemists. The concept physicalism is closely related, but the term is perhaps not a perfect fit since it has taken on conceptual connotations and baggage through its use by analytic philosophers of metaphysics. The connection is that in the psychological biosciences, the “hard problem of consciousness” looms over everything: “It is widely agreed that experience arises from a physical basis, but we have no good explanation of why and how it so arises. Why should physical processing give rise to a rich inner life at all? It seems objectively unreasonable that it should, and yet it does” (Chalmers, 1995). While the human mind and consciousness attract a special sense of awe, the hard problem of consciousness is not all that different from the problems facing attempts to make sense of the patient as a whole. Patients live; their bodies function every second of the day, via an astounding series of interconnected processes. It stretches the imagination to think that a vital spirit or such is giving unity to each life (human or non-); it stretches the imagination in another way to think that we humans are simply skin bags of chemical reactions.

2.2 Biomedical conceptions of health and disease

As Elizabeth Barnes puts it, “[i]n a nutshell, the problem is this: health is weird…We all care about health—our own and others. But we don’t know how to define it, how to quantify it, or how to relate it to other familiar things we care about (wellbeing, happiness, etc.).” (Barnes, 2023, p. 2). The preceding section on purpose in biomedicine leads directly to the related issue of how health and disease are conceptualized in biomedicine. This is something that will only be dealt with very briefly here, in part to avoid duplicating the content in the entry on concepts of health and disease. Debates over the meaning of health and disease—including how the two are connected—are central to philosophy of medicine. This entry will not attempt to summarize that complex literature, and rather focus on how conceptions of health and disease relate to biomedicine, including related disputes over how disease relates to disability justice matters, and ways in which purportedly objective biomedical conceptions of disease can be coopted for dubious purposes.

Of the different philosophical accounts of health and disease, Christopher Boorse’s naturalistic Biostatistical Theory (BST) of disease gives the account that is perhaps most tightly linked with the philosophical commitments of biomedicine. Boorse’s revised account of the BST states:

  1. The reference class is a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species.
  2. A normal function of a part or process within members of the reference class is a statistically typical contribution by it to their individual survival [or] reproduction.
  3. Health in a member of the reference class is normal functional ability: the readiness of each internal part to perform all its normal functions on typical occasions with at least typical efficiency.
  4. A disease [later, pathological condition] is a type of internal state which impairs health, i.e., reduces one or more functional abilities below typical efficiency (Boorse 2014: 684, amending Boorse 1977: 562).

The idea is that we can wield insights of biochemistry, pathology, and evolutionary biology to together yield an objective means of ‘reading’ nature to tell us which states are pathological or diseased states, without the interference of messy and culturally rooted/biased evaluations. One line of rebuttal is that there is no principled way of objectively choosing a reference class against which to judge that a given part or process is falling short (my blood sugar levels are objectively too high compared to…what exactly?) (Kingma, 2014). Even if that problem is resolvable, Krueger argues that an objective set of criteria for defining states as pathological or not would be a very limited accomplishment. Knowing that my blood sugar levels are objectively pathological does not really tell me much about what, if anything I or my physician ought to do about that (Krueger, 2015).

Fraught as it is to approach health via the functioning of components in the body, it is also quite conceptually difficult to measure health in a broader sense. Biomedical science practitioners tend to get twisted into conceptual and epistemic knots when attempting to measure general/overall health or well-being in a population (Alexandrova 2017; Hausman, 2015) (see section 3.3 Epistemology of measurement in biomedicine). One key philosophical dispute among health scientists engaged in patient health measurement activities is over what sorts/amounts of knowledge patients have about their own health states, and how this knowledge ought to be accessed (McClimans, 2024). How much can we glean about a patient’s physical comfort by asking them to rate their level of pain on a scale of 1–10? How do we solicit such information without repeating unethical patterns of trust or mistrust, rooted in racist/sexist/etc. stereotypes about patients (Buchman, Ho, & Goldberg, 2017)? In the case of disability, ableist biases are pervasive, distorting the vital communication channels between disabled patients and physicians (Peña-Guzmán and Reynolds, 2019).

The notion of disease as biological malfunction is also tied to a pair of critiques of the “medical model” of disability and of “medical model” of mental health. Both models are criticized for reducing the complexities of disability or psychological welfare to only the individual-level signs, symptoms, and variables recognized by biomedicine (see: disability: definitions and models). As traced in Hogan’s history of the concept, the medical model is either critiqued as insufficiently attentive to other dimensions (especially the social dynamics that drastically shape the relevant health experiences) or oppressive (since the model empowers biomedical experts to unilaterally dictate the disability/psychiatric categories, relevant evidence, diagnoses, treatments, etc.) (Hogan, 2019). This is in part a dispute over functioning since debates over normality, difference, and pathology depend on whether/how we commit to the notion that bodies or parts thereof have functions at all (Garson, 2019). If one’s legs do not perform the function of walking, are the legs pathological? Is the person with those legs inherently diseased? Disabled? Worse off than if they had legs that could walk? One solution is to simply throw out the notion of normal functioning (Amundson, 2000). Another related option is to embrace pluralism in the sense of accepting that the relationship between disability and well-being or health is complex, variable, and highly dependent on individual and social contingencies (Campbell & Stramondo, 2017). However, embracing pluralism is made more challenging by the fact that what counts as a good or thriving life is a cultural construct primarily shaped by non-disabled people’s values. For example, autistic people are surrounded by messages that autistic traits are inherent deficits, messages that are posed as objective truths, but that are in fact based on rigid expectations that people be sufficiently productive within the capitalist social order (Chapman, 2023).

One philosophical complication is that a naturalistic concept of disease, like Boorse’s, does not prevent social processes from altering the standards and practices of how the boundaries of these natural categories are drawn in practice. Chronic diseases such as cardiovascular diseases and type 2 diabetes have been targeted by drug companies to not only create new treatments but to redraw the boundaries between healthy vs. pathological, including boundary zones such as “prediabetes” (Greene, 2006). These efforts are in part accomplished via the design of clinical trials, which have the dangerous distinction of having very high epistemic value in the biomedical community, while remaining highly susceptible to manipulations to the experimental setup that push the evidence one direction or another (González-Moreno, Saborido, & Teira, 2015).

While a naturalistic concept of disease is the most consistent with the ontological assumptions and methodological practices of biomedicine, that has not prevented biomedicine from accommodating a certain type of dissent from the biomedical tenet that biomedicine ought to focus on diseases and (only) the biological, chemical, and physical aspects thereof (Krieger, 2011, p. 130). The World Health Organization (WHO)—founded in the same post-World War II period as biomedicine—adopted a holistic positive concept of health at its founding. I.e. it said that health is the presence of complete well-being (including mental and social well-being) rather than just the absence of disease. This created a direct tension with the core tenets of biomedicine, especially the reduction of disease to a set of concrete observable and measurable physical bases (Valles, 2018). Historically, the tension was resolved in the case of the WHO by the organization, shortly after its founding, effectively self-suppressing the use of its own definition of health in favor of pursuing a narrower set of initiatives to combat particular diseases (e.g., the celebrated Smallpox Eradication Program) (Irwin & Scali, 2007). This seems to have been in part because cold war politics made it pragmatic to not antagonize the United States with pushing a health concept concerned with “social” well-being, sounding a bit reminiscent of socialism (Irwin & Scali, 2007). While a WHO-type understanding of health is in genuine tension with the philosophical tenets of biomedicine, the tension is manageable in this case by simply pursuing areas of overlap between the different conceptions of disease (e.g., investing in infectious disease-control strategies for a population) while ignoring any purported aspects of health beyond the absence of pathologies. WHO-type understanding of health is declining to invest in assessing how human-environment relations contribute to a population’s misery, let alone its happiness and pleasure (Cooper, 2019 ; Kantor & Lindberg, 2020). This neglect extends to investigating the potential of the environment as a source of health (Malsch, Killin, & Kaiser, 2024).

3. Epistemology of Biomedicine

There are philosophical disputes happening at the heart of the biomedical enterprise and those disputes offer a means of understanding the epistemological dimensions of biomedicine: the nature of evidence and knowledge in the framework. The most contentious of those internal biomedicine disputes center on what the epistemology of biomedicine ought to be, with the rise of “evidence-based medicine” (EBM) being the event that provoked the largest segment of these disputes. By examining the disputes surrounding EBM, we can gain a better understanding of the epistemology of biomedicine, as illustrated in work such as Solomon’s Making Medical Knowledge (Solomon, 2015). Evidence-based medicine is a tricky concept, since its name misleadingly raises the question of who is practicing medicine that is not based on evidence (Goldenberg, 2006). Instead, the dispute is over which evidence is best and how it ought to be used. For instance, physicians will often advise patients on which home treatments to use for minor lower back pain, with individual physicians varying in which treatments they recommend, even aside from differences in the advice based on differing patient characteristics. Ibuprofen? Acetaminophen? Heat and/or cold compresses? Exercise? The standard twentieth-century medical response would be to let physician groups (including consensus groups convened for this purpose) lay out the options and perhaps use their collective expertise to make a recommendation, but giving great leeway to individual physicians to use their individual accumulated expertise to choose another of the available options seen as viable options by their peers. EBM instead treats this as a matter to be largely decided by empirical research. I.e., we ought to run randomized control trial experiments that compare the efficacy of alternative options by randomly assigning patients with lower back pain into Treatment A or Treatment B—controlling for the single variable—and measure the effects on patients using predetermined metrics (change in reported pain severity, incidence of major side effects, etc.). After doing multiple experiments we can then do a “systematic review and meta-analysis” that compiles the data trends across parallel research studies and helps us build an evidence base for creating guidelines for which treatment clinicians ought to use. Those guidelines dictate the proper default practices, which individual clinicians can contravene if specific individual patient needs are in conflict (e.g. a patient history of not responding well to a certain medication).

EBM began as a self-described Kuhnian scientific revolution of biomedicine—a fundamental change of worldview that is incommensurable with the previous one; a paradigm shift (Evidence-Based Medicine Working Group, 1992). The most fundamental dispute between advocates of the EBM movement and skeptics within the biomedical community is, in one sense, over the epistemic and power relationships between the two halves of biomedicine: biology and medicine. In biology, experimental methodologies and attempts to find generalizable population trends are valued highly; in clinical medicine, the single patient and the clinician’s accumulated (and ineffable) expert evaluation of them has long been valued very highly—much attention is paid to that individual patient’s contingencies (the particulars of their body and symptoms), with the clinician’s accumulated knowledge and knowhow being relied on when determining how to proceed. Evidence-based medicine is not a simplistic adoption of biology principles and their application to medicine; it is not the triumph of biology over medicine in biomedicine. Instead, EBM has helped to draw out deeper disagreements about what it means to do and use biomedical science well.

There is a large philosophical literature on evidence-based medicine, with the first monograph appearing in 2002 (Goodman, 2002). Most of the literature takes at least a partially skeptical stance on EBM practitioners’ various hardline stances on evidentiary matters: the suitability of clinicians relying primarily on brief synopses that attempt to synthesize massive bodies of evidence (Borgerson, 2009); the room for hidden biases in the process of evaluating medical data (Stegenga, 2011), and more. EBM has also inspired passionate disputes among clinicians over how to apply its principles (Berwick, 2005; Greenhalgh, Snow, Ryan, Rees, & Salisbury, 2015). One line of criticism is that its aims are noble, but have been hijacked by bad actors, namely corporations that learned that by getting involved in the production of randomized control trial evidence they could sway the evidence for the apparent safety and efficacy of their own products (Ioannidis, 2016). Philosophy of EBM is given extensive discussion in the entry on philosophy of medicine, and as with the rest of this entry, this entry will avoid needless repetition and keep the focus on biomedicine per se. For an introduction to the topic, see (Broadbent 2019).

3.1 Epistemology of expertise and experimental clinical data in biomedicine

Biomedicine is in a state of tension, between

  1. a history of resolving evidentiary disputes using mechanistic reasoning, consensus, and authority (see, e.g., Solomon [2015] on the roles played by ‘consensus conferences’) vs.
  2. a recent practice of creating predetermined evidentiary ranking/​evaluating procedures designed to minimize the ability of biased or erratic human judgments to unduly influence the resolution of evidentiary disputes.

Clinical guidelines were once routinely created by what is pejoratively called GOBSAT: Good Old Boys Sat Around A Table (and reached a consensus by talking amongst themselves as leading experts in the subject matter). As Greenhalgh puts it, “it is a major achievement of the EBM movement that almost no guideline these days is produced by GOBSAT!” (Greenhalgh, 2014, p. 7). It remains a point of philosophical contention just how epistemically different it is to generate clinical practice guidelines using a consensus-based model vs. an evidence-based model, in large part since, no matter what evidence is prioritized, a group of experts will ultimately need to interpret the data and make judgement calls on how to generate practical guidelines based on the compiled evidence (Djulbegovic & Guyatt, 2019). Though even the meaning of clinical expertise is itself not clearly defined and agreed upon, a matter further complicated by the way that the meaning of expertise is tangled up with views about what roles expertise ought to be playing in clinical practice (Wieten, 2018). Debates over expertise and the valuing of different forms of evidence are key to the proposed alternative frameworks seeking to reform, replace, or coexist with biomedicine (see Section 5).

Evidence-based medicine prizes certain types of biomedical evidence—highly controlled and systematic evidence—more highly than others. But that preference is a matter of much contention. As noted above, experimental evidence from a randomized experiment testing a treatment (a “randomized control trial”) is held as the best sort of evidence: the gold standard. The one exception is that “meta-analyses” of multiple experimental studies are perhaps a platinum standard better than gold (Stegenga, 2011). I.e. the thinking goes that the only evidence that might be better than such experimental data is a rigorous quantitative study rigorously looking for patterns and lessons by analyzing the results of many rigorous experimental studies. While the rigidity of EBM thinking gets a great deal of criticism, there are elements of the EBM’s philosophy that implement the sort of pragmatism that many critics desire, such as an epistemic openness in the community to engage in “open-ended critical inquiry” (Goldenberg, 2009).

3.2 Epistemology of basic and applied science in biomedicine

The status of laboratory evidence is a major point of contention in philosophy of biomedicine disputes. “Bench science” is often used as a catchall term in EBM for a wide variety of laboratory evidence (biochemistry, pathology, digital models of drug metabolism, animal studies of a treatment, etc.), and that evidence is pushed to the very bottom of the evidence hierarchy (B. Clarke, Gillies, Illari, Russo, & Williamson 2014). For example, green tea contains epigallocatechin gallate (EGCG), which seems to be effective at killing cancer cells in petri dishes and in mice (Eisenstein 2019). EBM supporters would be inclined to look down on inferences that green tea is therefore a wise anti-cancer home health behavior, until there is at least epidemiological evidence that green tea drinkers genuinely do have better cancer outcomes. Even then, EBM supporters would want to know if the anti-cancer effects are due to EGCG, some combination of multiple components of green tea, or perhaps just the relaxing social act of having a hot beverage. Biomedicine has always valued the sort of research that investigates EGCG in petri dishes, in mice, or other models used on the laboratory bench, but the dispute is over how reliable one takes that research to be for guiding real medical decisions (ought physicians tell patients to drink green tea?).

The problem of how highly to value bench science is distinct from the general objection to hierarchies of evidence (Bluhm, 2005). Even if evidence isn’t treated as inherently rankable in value, one key philosophical objection is that much of the biomedical research world is treated by EBM as less important than clinical patient experiments, or meta-analyses of such experimental data. Solomon explains that this position is in tension with a simultaneous trend in biomedicine, an increased concern with translational medicine (an effort to improve the process of moving candidate treatments from (the laboratory) bench to (the patient’s) bedside (Solomon, 2011). This effort to better manage the biomedical research enterprise has brought with it,

a restoration of the recognition that clinical research requires an engagement with basic theory (e.g., physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. (Solomon 2011: 451)

In an openly conciliatory move, the “EBM+” group of philosophers and clinicians (see Other Internet Sources), offers a defense of the view that mainstream EBM has erred by essentially relegating mechanistic evidence, such as EGCG having anti-cancer chemical properties, to a subsidiary role (B. Clarke et al. 2014).

3.3 Epistemology of measurement in biomedicine

While epidemiology-focused EBM is partly in tension with most of the rest of laboratory-focused biomedicine—needing it but seeing it as in service to randomized control trials on patients—both EBM and other branches of biomedicine are united by a valuing of precise measurement. While precise measurement is achievable in the biochemistry lab, the practical and philosophical challenges are thornier when doing measurement at the level of the whole person or the population. What is well-being (Alexandrova, 2017)? By what standards can we call a population healthy (Hausman, 2015)? What sorts of social structures, policies, and interventions are effective for promoting health (Valles, 2018)? How do we identify which subgroups are left out of the benefits and prevent injustices being done to them (Maglo, 2010, 2012)? What sorts of values are at stake when we debate biomedical evidence surrounding cultural issues such as birthing practices (McClimans, 2015)? A common theme shared by these critiques is a concern about the fickleness and contingency of measurement leaving much room for practitioners’ values and motivations to shape the results of the measurement process, for good or for ill (Keuck 2024; Tal 2024; see also Measurement in Science).

The biomedical quest for precise and objective measurements leaves some unsatisfied with the little room left for patient input in clinical care decision-making. What roles are there for patient input in the process of deciding the best course of treatment (Chin‐Yee & Upshur, 2018)? According to critiques, by trying to sideline subjective factors in medical care and replace them with increasingly objective factors, EBM especially (even among than other biomedical perspectives), risks losing the humanistic aspects of medicine, an ethical loss and an epistemic loss (See also, section 5.1 on humanistic medicine). By treating patients’ desires, goals, and values as largely irrelevant or a source of interference with an objective process, EBM loses sight of medicine as a means of helping real humans’ real problems. Relatedly, when healthcare decisions exclude patients' perspectives, the very concept of 'best treatment' loses its meaning. Even if a medical intervention achieves biologically optimal results, it cannot be considered truly successful if the patient experiences the outcome as diminished quality of life (McClimans, 2024).

In the background is the important—and meta-epistemic—problem that physicians struggle with uncertainty, and what to do in an objective measurement-focused field when one finds oneself lacking the desired evidence: inconclusive tests, treatments designed for patients unlike the one being treated, etc. Medical education has been criticized as inadequately preparing future physicians for the challenges of medical uncertainty (Mark R Tonelli & Upshur, 2019).

3.4 Reductionism in epistemology of biomedicine

In biomedicine, it appears much of medicine is reduced to applied biology—patients are just biochemical processes and medical knowledge is just a complicated form of biological knowledge. Keating and Cambrosio see the relationship between this reductionism in biomedicine (the reducing of medicine to biology) as more a matter of the two being aligned for complex historical and philosophical reasons, instead of that reductionism being philosophically central to biomedicine (Keating et al., 2003). According to them, after World War II, the fields of biology and pathology negotiated the creation of “the institutional and epistemic hybrid we call biomedicine,” and neither component of this hybrid rules the other (Keating et al., 2003, p. 368). They see this as undermining claims of biomedicine being reductionist because such assertions implicitly or explicitly mean that (micro)biology gets epistemic priority because it is the true and stable foundation.

Part of the challenge is that there are multiple varieties of reductionism in biology. And there are a number of different reductionism disputes in biology, and the overlaps with biomedicine vary—e.g., Rosenberg’s defense of reductionism in genetics overlaps with biomedicine in the area of medical genetics (Rosenberg 2006). As discussed in Section 1, it is very difficult to tell the difference between the core components of biomedicine and the bits of philosophy/technology/sociology that aren’t inherently part of biomedicine, but have gotten tangled up in it. The rationale for reductionism in biomedicine is explained with great care by Andersen:

Being able to successfully take a disease as complex as sickle cell anemia or Parkinson’s and reduce it to a single genetic error that cascades through various systems, even if that reduction holds for only a proper subset of cases, illustrates that reduction can be a powerful tool for research and explanation in medicine. It cannot be the only tool in the toolkit, since some diseases or dysfunctions may be only partially reducible, or for which only some cases are reducible. But it is a good working assumption, as Oppenheim and Putnam put it, in tackling a problem with an unknown etiology, to look for ways to reduce it to a few or even a single causal driver at a molecular level (Andersen 2016: 86).

In other words, the potential for success and record of prior successes is an argument for at least operating under the assumption that biomedical scholars ought to continue treating biomedical mysteries as biochemical puzzles for which the relevant pieces have not yet been identified or assembled. This critique offers a reply to the Krieger’s first tenet of biomedicine (See Section 1.1), the focus on biochemical processes. By contrast, other critics have been more concerned with the third tenet, the view of the body as a composite of distinct parts, rather than a unified whole.

Reductionism in biomedicine has been targeted by some committed critics. For instance, Marcum explains that the process of reducing the body to such component parts yields a vision of the body as machine, a radically dehumanizing move.

From the biomechanical point of view, the patient’s body is often perceived as a material object that can be reduced to a system of physical parts. That body is viewed as a machine composed of individual body parts, which can be fixed or exchanged with new parts, when broken. By reducing the patient’s body to an assemblage of body parts, the patient qua person vanishes (Marcum 2005: 318).

While the critique stands on its own, it remains an open question what other view ought to be adopted if not a reductionist biomechanical one. Marcum contrasts the view most directly to phenomenological views—which will be discussed in Section 5—arguing that a phenomenological approach is better suited to advancing medicine, which he presents as being in a state of crisis.

EBM’s reliance on randomized controlled trials as a cornerstone of health data collection doubles down on the general reductionism of biomedicine. Randomized controlled trials assume that health variables can be observed, manipulated and controlled as largely independent units. Yet, is a well-established problem that we simply don’t know all of the variables that might confound a clinical experiment (Worrall, 2007), so randomization can at most hope that the ‘confounders’ (e.g. unknown dietary factors that affect metabolization of a drug) are randomly distributed between the different treatment populations in an experiment. Taking the reductionism a step further, the goal of exactly measuring the differences between Treatment A and Treatment B requires EBM to only look for effects that are precisely measurable in the first place. This limitation is a deeply-rooted problem since even the official list of clinical signs and symptoms of a given disease can diverge from accumulated patient observations, and in cases such as some psychiatric conditions, the symptoms—or lack thereof—are overtly difficult to measure or factor into an assessment of treatment efficacy (e.g. one’s sense of self and/or emotional life) (Kendler, 2016).

While reductionist and antireductionist approaches are in direct opposition, it is possible to take a pluralistic stance toward them: both can be welcomed into health science. For instance, this is the position taken by Campaner (Campaner, 2010). Though, as discussed in the next section, the power of the biomedical institution makes it such that biomechanical reductionist approaches can easily overwhelm alternative views, which can lead to epistemic injustice and reduced health.

3.5 Epistemic injustice in biomedicine

Epistemic injustice is a set of conceptual tools used to analyze the harm done to individuals and communities in their capacity as knowers, as well as the effects of these harms on knowledge development and societal ignorance and silencing (see also social epistemology and feminist social epistemology). The sources of epistemic injustice can be individual or institutional bias (Fricker, 2007) or structural to the epistemic system itself, with historical contingencies (Dotson, 2011; 2012; 2014). Two central forms of epistemic injustice have been discussed in the biomedical context: testimonial and hermeneutical injustices (Fricker, 2007). Fricker argues that testimonial injustice “occurs when prejudice causes a hearer to give a deflated level of credibility to a speaker's word” while hermeneutical injustice occurs “when a gap in collective interpretive resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences” (Fricker, 2007, p.1). Over time, these concepts have been expanded and have become more nuanced (e.g., Hookway, 2010; Kukla, 2014; Mason, 2011; Medina, 2017; Wanderer, 2017). In the context of health, epistemic injustice has been attributed to biomedicine's epistemic commitments, which often prioritize narrow, reductionist perspectives. Institutional practices, policies, and dynamics can contribute to deepening health inequalities and, as such, to increased epistemic injustice. See Section 4 on Biomedicine as an Institution.

Testimonial and hermeneutical injustice have been discussed in the medical context in relation to classification, diagnosis, and treatment of maladies and healthcare allocation. Among the vulnerable populations who suffer from testimonial injustice are immigrants (Castañeda, 2022), children (Carel & Györffy, 2014), patients with specific psychiatric conditions, young psychiatric patients, patients with psychiatric-somatic comorbidity (Bueter, 2021; Bortolotti, 2025), and the disabled (Peña-Guzmán & Reynolds, 2019). Hermeneutical injustice has been discussed in the context of psychiatry and neurodevelopmental disorder (e.g., Bueter, 2019; Chapman & Carel, 2022; Drożdżowicz, 2021; Ritunnano, 2022; Spencer, 2023; Spencer, & Kidd, 2023; Bortolotti, 2025), phenomenology of illness (Kidd & Carel, 2017, 2018), and medicalization (Wardrope, 2015), to name a few. In addition, the negative experiences of the ill that arise from the epistemic prejudices and hermeneutical difficulties within healthcare and in society were also labelled by Kidd and Carel (Kidd & Carel, 2019) as ‘pathocentric epistemic injustice’. Furthermore, specific forms of epistemic injustice in the medical context were identified. These forms include epistemically unjust concepts of disease/disorders and health (Kidd & Carel, 2019), hermeneutical death (Medina, 2017), preemptive testimonial injustice (Bueter, 2019), or wrongful depathologization (Spencer & Carel, 2021).

To address epistemic injustice in biomedicine, it is essential to foster inclusivity, value diverse perspectives, and reform institutional structures to meet the needs of all patients. However, the use of epistemic injustice has also raised descriptive and normative challenges of inclusion of experiential knowledge in the contexts of mental health care (Dings & Strijbos, 2025) and worries that an imbalanced approach impedes legitimate and potentially valuable inquiry of unexplained illness (e.g., chronic Fatigue syndrome) (Byrne, 2020). While the concept of epistemic injustice is receiving increasing philosophical attention, the concept of epistemic justice still lacks philosophical depth (Kidd, Spencer, & Carel, 2023; Côté, 2024).

4. Biomedicine as an Institution

4.1 Biomedicine and colonial power

The disputes over biomedicine’s virtues and flaws are tied to the other aspects of Western cultural-political-economic influence that coevolved with it, and travelled with it around the globe. The dynamics between the institution of biomedicine—rooted in wealthy Western countries—and low/middle-income countries is in part a manifestation of the complexities of the international political scene. See, for instance, the literature on international distributive justice.

As discussed in Section 1.2, biomedicine co-evolved with the West’s social and economic institutions in the aftermath of World War II. Of particular importance, the individualism of Western capitalism has meshed with biomedicine’s ontological view of the body as effectively separable from its social context. Briggs and Hallin describe how contemporary media and biomedicine work to coproduce public knowledge about health and disease, a process they dub biomediatization (Briggs & Hallin, 2016).

Biomedicine has been used as one prong of colonial power dynamics between Western institutions and non-Western peoples (including indigenous peoples) (see: (Millum & Emanuel, 2012)). Colonial governments’ overt policies (e.g. medical licensing standards) and subtler cultural imperialism (e.g. media depictions of traditional healers as frauds or fools) have long undermined or directly attacked local/indigenous medical frameworks and institutions. And since biomedical education and practice are based on technologies and education from the West, low- and middle-income countries are left dependent on wealthy Western countries (Nunn, 2009). As a result, local would-be biomedical practitioners often travel to the West for biomedical education and then have little incentive to return to their home countries to practice techniques for which they will have relatively few biomedical tools, lower pay, etc. This raises further ethical questions related to which entities have which individual/collective responsibilities to address this so-called ‘brain drain’ trend (Yuksekdag, 2020). Meanwhile, non-governmental organizations such as the Red Cross offer medical aid, but generally in the form of sending temporary trained personnel from the West, rather than building sustainable local capacity for medical training and practice. And well-meaning Western biomedical students travel to the same low- and middle-income countries, with limited knowledge of the populations or their health needs, a lack of preparation that can be harmful (Pinto & Upshur, 2009).

4.2 Biomedicalization

To grasp the concept of biomedicalization, it is crucial to explore its roots in critical social analysis and the concept of medicalization. Medicalization describes the expansion of medical jurisdiction over phenomena that were not considered medical before. Medicalization occurs when aspects of life are defined as medical conditions that should receive medical attention. Traditionally, ‘medicalization’ has been used mainly with a negative connotation, to describe problematic processes. In recent years it has been used as a neutral or descriptive term (Kukla, 2022; Rose, 2007; Sadler, Jotterand, Lee, & Inrig, 2009) –similarly to ‘scientific imperialism’ –with ‘over-medicalization’ being used to describe undesirable processes.

The contemporary anti-medicalization stance is historically rooted in the anti-psychiatry movement and has been reinforced by the feminist, anti-racist, and LGBT movements (see for example the cases of homosexuality and drapetomania in Concepts of Health and Disease). Anti-psychiatry drew awareness to the power structures involved in pathologizing oppressed groups and the surveillance power of medical institutions (Hagner, 2003). Michel Foucault’s famous work on madness is critical of how society has treated those deemed “mad” (M Foucault, 1967). Foucault argues that the treatment of the mad reflects broader power dynamics and social control mechanisms, and it is often oppressive and dehumanizing. Thoms Szasz’s (T. Szasz, 2007; T. S. Szasz, 1960) argument that mental illness is a metaphor and not an actual natural condition, is also central to the anti-psychiatry critique.

The anti-medicalization stance expanded beyond psychiatry, finding similar problems in other areas of medicine. In Foucault’s historical works The Birth of the Clinic (M Foucault, 2012 [1963]) and The history of sexuality (Michel Foucault, 1990 [1976]) he highlights aspects of (bio)medicine: dehumanization, reductionism, measurement and observation methods of dubious value, and the problem of the medical institutional power (bio-power) that controls and oppressively surveils the population. Foucault's work shows that the process of medicalization was closely intertwined with the development of modern capitalism and state power. This criticism of medicine as an institution has been reinforced by the prominent work of sociologists Irving Kenneth Zola (Zola, 1976) and Peter Conard (Conrad, 1975) and in the social critic of Ivan Illich. In Medical Nemesis (Ilich, 1974), Illich’s influential critique of medicine, he argues that (bio)medicine both has the wrong goals (he valorizes death, disease, and pain as proper components of the human experience, rather than enemies to be automatically and constantly opposed) and fails to fulfill its own goals (iatrogenic disease—harms caused by medical treatment—are a large component). Examples of recent debates on (over)medicalization include pregnancy and childbirth, disability (Peña-Guzmán & Reynolds, 2019), Gender dysphoria (Butler, 2004), grief (Solomon, 2021).

In addition, the debate on (over) medicalization also refers to conditions that are framed as biomedical and are treated at the individual level, but are arguably social and systematic problems, such as the debate on alcoholism (Midanik, 2004) and excited delirium (Fischer & Jukola, 2024). Similarly, philosophers have criticized the genetic focus of biomedicine as a distraction from environmental and social problems (Tabery, 2023).

Traditionally, critiques of over-medicalization undermine the understanding of aspects of human biology (e.g. feeling sadness during grief) as states of illness, and calls for removing them from medical jurisdiction. However, in recent years, this debate has expanded from the sick role to preventive medicine, including association with risk groups and the preservation of health (what is known as salutogenesis). While identifying a risk factor for a disease can prevent the disease, it can also lead to overdiagnosis. While overdiagnosis differs from medicalization (Hofmann, 2016), both are matters of concern in which medicine harms instead of helps, by excessively intruding in human life. Together with health preservation, we see that the social and ethical worries associated with biomedicine as an institution of surveillance and control are not restricted to what counts as a disease. So, while over-medicalization is one avenue for criticizing biomedical institutions, the surveillance and control exercised by biomedicine as an institution occurs through multiple avenues.

Kukla (2022) argues that conceptual resources are controlled by dominant and hegemonic groups, which also leads to the concern that the concept of health can be used against subgroups in a society. Metzl and Kirkland’s influential edited volume Against Health: How Health Became the New Morality lays out a related case for how biomedicine exercised undue influence over culture, including casting health ills as personal failings deserving of public shaming and stigmatization (Metzl & Kirkland, 2010). As an illustration of the sort of stigmatizing strategies that they condemn as unacceptable, bioethicist Daniel Callahan ethically endorsed the social practice of ‘fat shaming’ as a means of promoting public health (Callahan, 2016). Empirical arguments on the harms of stigmatization (Hatzenbuehler, Phelan, & Link, 2013), and contrary ethical arguments (Dean, 2018), both rebut stigma as an ethically viable health-promoting intervention. Health/body stigma, public rhetoric over health, and moralism about health behaviors are all subjected to scrutiny in critiques of ‘self-care’ strategies, e.g. telling ‘overweight’/overtired/overworked employees feeling stressed by their jobs that they should take better care of themselves by doing yoga, more closely monitoring their eating at work, etc. The critique is that the biomedical model can recast social problems (including outright abuses—usually capitalist ones) as individual responsibilities. Self-care can go well when it empowers, such as the Women’s Health Movement of the 1960s and 1970s that fought against sexism by calling upon women to know their own bodies and value that knowledge (Bueter, 2017). Or self-care can become regressive when it becomes “inner-directed, authoritarian, victim-blaming, manipulated by dominant forces, or diversionary from struggles for radical change in both medicine and the broader society” (Sidel & Sidel, 1981, p. 656).

The growing emphasis on health and the development of risk and surveillance-based medicine is considered one of the five key processes that influence the development, and are shaped by, what Clarke et al. (2003) call “biomedicalization.” Clarke et al. define biomedicalization as the integration of technoscientific innovation (Latour, 1987) into medicine since about 1985. As Clarke et al. explain, “a new focus on health and risk and surveillance biomedicines” is one of the five key processes of biomedicalization: “Biomedicalization is co-constituted through five central (and overlapping) processes: major political economic shifts; [...] the technoscientization of biomedicine; transformations of the production, distribution, and consumption of biomedical knowledges; and transformations of bodies and identities. We emphasize historical developments in the transitional and current biomedicalization era” (Clarke et al. 1985, p. 166). While biomedicalization has not been largely embraced as a critical concept, the concept of medicalization is still persistence in philosophical work concerning biomedicine, displaying the longer roots to many of the epistemic commitments identified to biomedicine. To repeat the point made in Section 1, “medicine” and “biomedicine” are often used interchangeably. It is not clear why biomedicalization has received so little explicit attention, given that many critiques of medicalization target core features of biomedicine.

Some philosophers have critically examined the limitations of this framework as a tool for analyzing contemporary health issues. Building on Nikolas Rose's critique in “Beyond Medicalization,” where he contends that “medicalization has become a cliché of critical social analysis” (Rose, 2007, p. 700), Bell and Figert (2015) call for a move beyond the repetitive revision of “-ization” frameworks, which they see as inherently limited in scope. Bell and Figert argue that “-ization” discourses often prioritize individual-level explanations and solutions, therefore obscuring the systemic and global dimensions of health inequities. Alternatively, they advocate for a broader approach that embraces the complexity of health disparities and integrates insights from multiple fields to address the structural and social determinants of health.

An example of such an approach could be found in the work of Keating and Cambrosio (Keating & Cambrosio, 2003), who suggest analyzing the new configuration between medicine, biology, and technology as ‘biomedical platforms.’ A biomedical platform is a way of arranging instruments, individuals, and programs. By entering the high-tech domains, biomedical platforms generate both innovation and routines, creating a new alignment between the normal and the pathological (Keating & Cambrosio, 2003). A prominent example of a biomedical platform is the genomics platform that enables the sequencing and analysis of DNA profiles and generates genetic biomarkers. These are used for disease treatment and health preservation. Biomedical platforms could be seen as a more encompassing framework than biomedicalization, and can be used to conduct a critical analysis of biomedicine.

4.3 Biomedical policy and decision-making: the case of COVID-19

The arrival of the global COVID-19 pandemic serves as an illustration of the powers and limitations of the biomedical institutions that have been built up since the mid-20th century. Biomedical institutions responded to a new pathogen by making use of its three epistemological tenets identified by Krieger (See Section 1.1): 1) that the pandemic is fundamentally a biological phenomenon, with normative and sociopolitical aspects being incidental non-scientific considerations separable from the core problem, 2) that the new viral pathogen is a problem that needs to be identified and distilled down using the tools of the laboratory, and 3) that a (properly reductionist) understanding of the new disease is to be found in the laboratory, and similarly for any solution to the problems created by the disease.

Just two months after the online publication of the genetic sequence data of the virus that came to be called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the American biotech company Moderna had designed a new vaccine for it. The design process of the vaccine itself took only two days, and initial tests of the vaccine in humans started two months later. It was so incredibly fast a process because the company had access to a flexible vaccine template based on messenger RNA. Within a year of the vaccine being isolated and sequenced, the first mass vaccination campaigns had begun, with several vaccines becoming available in quick succession. Yet the conceptualization of COVID-19 mitigation as a biomedical challenge led to the sidelining of other forms of knowledge, particularly social scientific knowledge, such as economics (e.g. how housing and labor conditions affect COVID-19 dynamics) (Lohse and Canali, 2021). Moreover, biomedicine’s prioritizing of experimental evidence, preferably from randomized control trials, led to expert disputes over what counts as a sufficient scientific evidence basis for promoting widespread mask-wearing. Mechanistic evidence about virus size and mask filtration capabilities pointed to masks being an effective tool, but many experts demanded that more extensive experimental evidence be acquired before promoting widespread mask-wearing (Muller, 2021). These disputes connected with wider social and cultural debates over masking.

The US capitalized on longstanding ties between governmental entities, including the biomedical funding powerhouse National Institutes of Health, and the private pharmaceutical industry, providing virtually unlimited funds to accelerate the development of the vaccines. Worldwide, “vaccine nationalism” took hold, with the US and other high-income countries snapping up doses of vaccines through bulk contracts with pharmaceutical companies, leaving residents of low- and middle-income countries with a paltry number of donated doses (Collste 2022). Within high-income countries, widespread hesitancy to taking the vaccines moved debates over vaccine hesitancy from focusing on children to newly focusing on adults. Trust in science—more specifically the biomedical branch of science—became the new point of dispute. What is the nature of mistrust in vaccines (de Melo-Martin 2022)? Is more trust warranted (Goldenberg 2021)? Ethical critiques of vaccine hesitant people can be unethical themselves (see Section 3.4 on Epistemic Injustice) (Cassam, 2021). Trust in official vaccine guidelines is intertwined with trust in government (Jasanoff et al., 2021).

5. Alternative Frameworks

Biomedicine is not the only framework for understanding health and medicine. There are a range of alternatives, from traditional medicine frameworks that predate biomedicine to biomedically-based systems that seek to improve biomedicine incrementally. It is a matter of open debate how much any one of these systems is commensurable with biomedicine’s core set of epistemological commitments and institutional structures (specialty-based hospital hierarchies, etc.).

5.1 Humanistic Medicine

Humanistic medicine is both a theory (Bolton, 2020; Cassell, 2004, 2012; Marcum, 2008; Robinson, 1939; Woods, 2017) and a set of values and practices. In the heart of humanistic medicine is the patient as a person, and its agency.

Among the numerous humanistic critiques of biomedicine, coming from the broad field of medical humanities (for an overview, see: Marcum, 2008), philosophers have paid particular attention to narrative and phenomenology (Ferry-Danini 2018).

Narrative medicine offers a revision to the biomedical model alternative based around the centrality of the story or narrative in human life (Charon, 2008). This notion that narrative is central to human experience offers a variety of potential operationalizations in clinical biomedical practice. For instance, it places additional value on the patient consultation and asks for improved active listening skills among clinicians, who must learn to elicit, receive, and understand patients’ stories about their health conditions. Such listening has many potential benefits, including the potential to understand the meaning(s) of what human dignity means for a given patient, an important benefit given that biomedical settings are known for being “dehumanizing” (Parsons & Hooker, 2010). Though, the proposition that humans are indeed narrative beings has itself been disputed (Woods, 2011). In addition, the construction of one’s own narrative is already done through biomedical narratives, and therefore not entirely independent of them (Laforest, 2020). The variability among people underscores a broader imperative: both narrative and biomedical models must resist one-size-fits-all assumptions.

The Biopsychosocial model (Engel, 1977, 1978, 1980) provides an alternative to the biomedical model that only looks for the biological causes for disease by giving account to the psychology of the patient and its social environment. However, the Biopsychosocial model is still focused on a (naturalistic) understanding of disease and lacks agential recognition (Bolton, 2020; Bolton & Gillett, 2019). As such, it does not fulfill the phenomenologists' requirement of taking illness seriously (Carel, 2016). The gap between the third-person perspective and the subjective first-person perspective on illness is captured by Svenaeus (2019) in his defense of phenomenological account of health and illness. There, he argues that a person’s feelings, everyday life, and life story “needs to be taken into account in its own right” (Svenaeus, 2019, p. 465). A new variation of the Biopsychosocial model suggests to incorporate agential recognition (Bolton & Gillett, 2019), however, this model is still not in use in medical practice.

The growing awareness of the importance of recognizing the patient as a person and an autonomous agent led to the growth of “patient-centered care”. The patient-centered care approach, refocuses attention on the patient instead of their disease (El-Alti, Sandman, & Munthe, 2019; Hanemaayer, 2021; Marcum, 2021). As such, it promotes patient empowerment and participation in decision-making and focuses on tailoring care to individual patient needs. Patient-centered care and values of participation and personalization are also common in other initiatives, such as personalized medicine (known also as precision medicine, and P4 medicine).

Personalized medicine is often presented as an alternative to “one-size-fits-all medicine” approach of Evidence-Based Medicine. Personalized medicine describes itself as a holistic initiative, partially because it aims at including the patient as a person (Vogt, Hofmann, & Getz, 2016); however, so far, it is not fulfilling its holistic promise (Vogt, Ulvestad, Eriksen, & Getz, 2014). Personalized medicine’s manifestation of patients’ participation in their own medical care has been criticized as very limited. Personalized medicine instead focuses mainly on compiling and using more precise data, in processes that are driven by economic and political interests, rarely benefitting the patients themselves (Prainsack, 2017).

Personalized medicine creates limited new patient participation roles via increasing use of tracking technologies, like wearables. While they allow greater autonomy for some people, they have a potential to harm users’ substantive relational autonomy by manipulating their decisions and behaviors for the benefit of businesses (e.g. employers seeking to control workers' health) (Owens & Cribb, 2019), and contribute to commodifying the surveillance of bodies (Svenaeus, 2023). In addition, the gap between the user and its ‘quantified self’ (Lupton, 2016a, 2016b), can create alienation of the user from their body, generate anxiety and data-doubt (Lomborg, Langstrup, & Andersen, 2020), and change illness experience and symptoms formation (Hofmann & Svenaeus, 2018). As a result of these changes, tracking technologies can affect the epistemic division of labor between the different actors in the medical realm (Friedman, 2024). Patient participation via the use of tracking technologies also puts more responsibility on the patients (or users) for their condition. In recent discourse, in which the problem of stress has garnered increased attention, “controlling the health problems associated with living in stressful situations therefore becomes the responsibility of the individuals—all too often, the responsibility of individuals who are already disadvantaged by their economic status, their race, or their social position more generally” (Kaplan, 2019, p. 116). Instead of focusing on and intervening in the social determinants of health and disease, Personalized medicine imposes new burdensome responsibilities on the already-vulnerable.

That is to say, although some alternative initiatives and frameworks share values with humanistic medicine in their vision, they are, in practice, offshoots of biomedicine more than they are alternative frameworks that would replace biomedicine.

5.2 Gentle medicine

Stegenga has argued in favor of “gentle medicine,” a conservative treatment mindset that stands in contrast to the biomedical pursuit of ever-more interventions (Stegenga, 2018)—a pill for each ailment. This is in one sense a challenge to biomedicine more in quantity than in quality; he does not advocate for switching from pills to naturopathic diet-based treatments. He recommends this (purportedly gentler) conservatism as a response to an epistemic devaluing of biomedicine knowledge which he calls: “medical nihilism…the view that we should have little confidence in the effectiveness of medical interventions” (Stegenga, 2018, p. 1). This follows in the loose tradition of other writings, such as the text by Illich discussed at the start of Section 5 (Illich, 1976); see also Section 4.2 on anti-medicalization. But Stegenga’s critique and replacement remain a radical challenge to biomedicine in the sense that it undercuts the epistemic practices of biomedicine and pushes back on the institutional practices (and the related infrastructure, including massive pharmaceutical companies) by arguing that (bio)medical treatments ought to be applied sparingly.

5.3 The population health framework

Valles offers an alternative—the population health framework—that partly meshes with Stegenga’s concluding suggestion that “gentle medicine” ought to be accompanied by interventions that refocus health promotion efforts on social determinants of health, including “clean drinking water, better nutrition, and greater socio-economic equality” (Stegenga, 2018, p. 198). Valles expounds and defends the merits of the population health framework, a view developed in response to frustrations with biomedicine that coalesced in the 1990s in Canada as an alternative theoretical framework, before expanding internationally (Evans, Barer, & Marmor, 1994; Valles, 2018). The population health framework is not nihilistic about medical care, but rather seeks to decenter medicine and healthcare in the overall pursuit of health; most of the problems and most promising solutions to ill health lay outside the scope of biomedicine (safer workplaces, an end to racist housing discrimination, neighborhoods where people can safely walk, socialize and play, etc.) (Valles, 2018).

5.4 Traditional healing practices

“Complementary, alternative, or integrative medicine” is biomedicine’s ‘big tent’ category for non-biomedical systems of health care (See Other Internet Sources, NCCIH). Philosophers have pointed out that biomedicine, specifically evidence-based medicine, puts advocates of such non-biomedical systems into a no-win position. One such philosophical challenge is that some of the claims made by non-biomedical systems are claimed to be non-measurable experiences, e.g., the experience of Qi life force in traditional Chinese Medicine (Mark R. Tonelli & Callahan, 2001). This means that advocates have to either submit to the epistemological framework of biomedicine (which may be incapable of assessing some of the effects claimed to exist), or refusing to play by medicine’s rules and hence being dismissed as quackery by biomedicine. Epistemically, it seems like the latter option is the better option, but it would require advocates to “work to develop new research designs and new standards of evidence that reflect their approach to medical care” (Borgerson, 2005, p. 502).

Classical Chinese Medicine (CCM) remains practiced in communities around the world, and Lee draws out two core philosophical differences between CCM and biomedicine. First, CCM has “a process ontology—it considers causal relationships between events and processes to be foundational, rather than things” (Lee, 2017, p.2). Second, it is holistic—“the universe and everything in it, including human beings, constitute wholes which are different from the sum of their parts, and which in turn are related and as well as inter-related with other wholes” (Lee, 2017, p. 14). It is within this philosophical system that treatments such as acupuncture and herbal/dietary remedies are used. While the gulf between biomedicine and CCM is wide, it is not entirely dissimilar from some Western scientific practices: CCM’s approach to health and the human body bear some resemblances to the ways that epidemiologists approach populations’ health and how ecologists approach ecosystems. Among other similarities, in both fields there is great respect for balance and dynamic interconnected processes (Lee, 2021).

Ayurvedic medicine takes a somewhat similarly holistic and balance-oriented approach to the person and their health (Rastogi, 2014) (note also that holistic bodily balance is central to the Hippocratic medicine described in Section 1.2). One way that manifests in Ayurvedic practice—in contrast with biomedicine—is that the biological characteristics of two individuals might be similar but their recommended treatments might be quite different. For instance, while biomedicine routinely hands out standardized advice on what sorts of foods are best for someone of a given age and sex, Ayurvedic medicine rejects the assumption that such standardization within a single age-sex grouping is even a good default. Other factors play larger roles than in biomedicine, including bodily changes over the course of the day and one’s (internal) body type (affecting how one metabolizes specific foods, etc.). Complicating matters is that Ayurvedic medicine gradually developed in South Asia’s diverse cultural and religious history (Desai, 1988), cohering into a set of written texts in the 7th century CE (Maas, 2018).

Bibliography

  • Alexandrova, Anna, 2017, A Philosophy for the Science of Well-Being, New York: Oxford University Press.
  • Amundson, Ron, 2000, “Against Normal Function,” Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 31(1): 33–53.
  • Andersen, Holly, 2016, “Reductionism in the Biomedical Sciences,” in Miriam Solomon, Jeremy R. Simon, and Harold Kincaid (eds.), The Routledge Companion to Philosophy of Medicine, New York: Routledge, 130–142.
  • Barnes, Elizabeth, 2023, Health Problems: Philosophical Puzzles About the Nature of Health, New York: Oxford University Press.
  • Bell, Susan, and Anne Figert, 2015, “Moving Sideways and Forging Ahead: Reimagining ‘-izations’ in the Twenty-First Century,” in Susan Bell (ed.), Reimagining (Bio)medicalization, Pharmaceuticals and Genetics, New York: Routledge, pp. 19–40.
  • Berwick, D. M., 2005, “Broadening the View of Evidence-Based Medicine,” BMJ Quality & Safety, 14(5): 315–316.
  • Bluhm, Robyn, 2005, “From Hierarchy to Network: A Richer View of Evidence for Evidence-Based Medicine,” Perspectives in Biology and Medicine, 48(4): 535–547.
  • Bolton, Derek, 2020, “The Biopsychosocial Model and the New Medical Humanism,” Archives de Philosophie, 83(4): 13–40. doi:10.3917/aphi.834.0013.
  • Bolton, Derek, and Grant Gillett, 2019, The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments, Cham: Springer Nature Switzerland.
  • Boorse, Christopher, 2014, “A Second Rebuttal on Health,” Journal of Medicine and Philosophy, 39(6): 683–724.
  • Borgerson, Kristin, 2005, “Evidence-Based Alternative Medicine?” Perspectives in Biology and Medicine, 48(4): 502–515.
  • Borgerson, Kristin, 2009, “Why Reading the Title Isn’t Good Enough: An Evaluation of the 4S Approach to Evidence-Based Medicine,” International Journal of Feminist Approaches to Bioethics, 2(2): 152–175.
  • Bortolotti, Lisa, 2025, Epistemic Justice in Mental Healthcare: Recognising Agency and Promoting Virtues Across the Life Span, Cham: Palgrave Macmillan.
  • Briggs, Charles, and Daniel Hallin, 2016, Making Health Public: How News Coverage Is Remaking Media, Medicine, and Contemporary Life, Oxon: Routledge.
  • Broadbent, Alex, 2009, “Causation and Models of Disease in Epidemiology,” Studies in History and Philosophy of Biological and Biomedical Sciences, 40(4): 302–311.
  • –––, 2019, “Evidence-Based Medicine,” in Philosophy of Medicine, New York: Oxford University Press, 131–156.
  • Buchman, Daniel, Anita Ho, and Daniel Goldberg, 2017, “Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain,” Journal of Bioethical Inquiry, 14(1): 31–42.
  • Bueter, Anke, 2017, “Androcentrism, Feminism, and Pluralism in Medicine,” Topoi, 36(3): 521–530.
  • –––, 2019, “Epistemic Injustice and Psychiatric Classification,” Philosophy of Science, 86(5): 1064–1074.
  • –––, 2021, “Diagnostic Overshadowing in Psychiatric-Somatic Comorbidity: A Case for Structural Testimonial Injustice,” Erkenntnis, 88: 1135–1155.
  • Butler, Judith, 2004, Undoing Gender, New York: Routledge.
  • Bynum, William, 2008, The History of Medicine: A Very Short Introduction, New York: Oxford University Press.
  • Byrne, Eleanor, 2020, “Striking the Balance with Epistemic Injustice in Healthcare: The Case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis,” Medicine, Health Care, and Philosophy, 23(3): 371–379.
  • Callahan, Daniel, 2016, The Five Horsemen of the Modern World: Climate, Food, Water, Disease, and Obesity, New York: Columbia University Press.
  • Campaner, Rafaella, 2010, “Reductionist and Antireductionist Stances in the Health Sciences,” in Thomas Uebel, Stephan Hartmann, Wenceslao Gonzalez, Marcel Weber, Dennis Dieks, and Friedrich Stadler (eds.), The Present Situation in the Philosophy of Science, Dordrecht: Springer, pp. 205–218.
  • Campbell, Stephen, and Joseph Stramondo, 2017, “The Complicated Relationship of Disability and Well-Being,” Kennedy Institute of Ethics Journal, 27(2): 151–184.
  • Carel, Havi, 2016, Phenomenology of Illness, New York: Oxford University Press.
  • Carel, Havi, and Gita Györffy, 2014, “Seen but Not Heard: Children and Epistemic Injustice,” Lancet, 384(9950): 1256–1257.
  • Cassell, Eric, 2004, The Nature of Suffering and the Goals of Medicine, New York: Oxford University Press.
  • –––, 2012, The Nature of Healing: The Modern Practice of Medicine, New York: Oxford University Press.
  • Castañeda, Heide, 2022, Migration and Health: Critical Perspectives, New York: Routledge.
  • Chalmers, David, 1995, “Facing Up to the Problem of Consciousness,” Journal of Consciousness Studies, 2(3): 200–219.
  • Chapman, Robert, 2023, Empire of Normality: Neurodiversity and Capitalism, Las Vegas: Pluto Press.
  • Chapman, Robert, and Havi Carel, 2022, “Neurodiversity, Epistemic Injustice, and the Good Human Life,” Journal of Social Philosophy.
  • Charon, Rita, 2008, Narrative Medicine: Honoring the Stories of Illness, New York: Oxford University Press.
  • Chin-Yee, Benjamin, and Ross Upshur, 2018, “Clinical Judgement in the Era of Big Data and Predictive Analytics,” Journal of Evaluation in Clinical Practice, 24(3): 638–645.
  • Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer Fishman, 2003, “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine,” American Sociological Review, 68(2): 161–194. doi:10.2307/1519765.
  • Clarke, Brendan, Donald Gillies, Phyllis Illari, Federica Russo, and Jon Williamson, 2014, “Mechanisms and the Evidence Hierarchy,” Topoi, 33(2): 339–360.
  • Conrad, Lawrence, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear, 1995, The Western Medical Tradition: 800 BC to AD 1800, Cambridge: Cambridge University Press.
  • Conrad, Peter, 1975, “The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior,” Social Problems, 23(1): 12–21. doi:10.2307/799624.
  • Cooper, Amy, 2019, State of Health: Pleasure and Politics in Venezuelan Health Care Under Chávez, Oakland: University of California Press.
  • Côté, Catherine, 2024, “A Critical and Systematic Literature Review of Epistemic Justice Applied to Healthcare: Recommendations for a Patient Partnership Approach,” Medicine, Health Care and Philosophy, 27(3): 455–477..
  • de Melo-Martín, Immaculada, 2022, “Vaccine Hesitancy: Some Concerns About Values and Trust, Comments on Vaccine Hesitancy by Maya J. Goldenberg,” IJFAB: International Journal of Feminist Approaches to Bioethics, 15(2): 108–115.
  • Dean, Megan, 2018, “Eating Identities, ‘Unhealthy’ Eaters, and Damaged Agency,” Feminist Philosophy Quarterly, 4(3): 1–32.
  • Desai, Prakash, 1988, “Medical Ethics in India,” Journal of Medicine and Philosophy, 13(3): 231–255.
  • Dings, Roy, and Derek Strijbos, 2025, “Being in a Position to Know: Attuned Responsiveness as the Hallmark of Experiential Knowledge and Expertise in Mental Healthcare,” Frontiers in Psychiatry, 15.
  • Djulbegovic, Benjamin, and Gordon Guyatt, 2019, “Evidence vs Consensus in Clinical Practice Guidelines,” JAMA, 322(8): 725–726.
  • Dotson, Kristie, 2011, “Tracking Epistemic Violence, Tracking Practices of Silencing,” Hypatia: A Journal of Feminist Philosophy, 26(2): 236–257.
  • –––, 2012, “A Cautionary Tale: On Limiting Epistemic Oppression,” Frontiers: A Journal of Women’s Studies, 33(1): 24–47.
  • –––, 2014, “Conceptualizing Epistemic Oppression,” Social Epistemology, 28(2): 115–138.
  • Drożdżowicz, Anna, 2021, “Epistemic Injustice in Psychiatric Practice: Epistemic Duties and the Phenomenological Approach,” Journal of Medical Ethics, 47(12): e69.
  • Eisenstein, Michael, 2019, “Tea’s Value as a Cancer Therapy Is Steeped in Uncertainty,” Nature, 566: S6–S7.
  • Engel, George L., 1977, “The Need for a New Medical Model: A Challenge for Biomedicine,” Science, 196(4286): 129–136. doi:10.1126/science.847460.
  • –––, 1978, “The Biopsychosocial Model and the Education of Health Professionals,” Annals of the New York Academy of Sciences, 310: 169–187. doi:10.1111/j.1749-6632.1978.tb22070.x.
  • –––, 1980, “The Clinical Application of the Biopsychosocial Model,” American Journal of Psychiatry, 137(5): 535–544. doi:10.1176/ajp.137.5.535.
  • Evans, Robert G., Morris L. Barer, and Theodore R. Marmor (eds.), 1994, Why Are Some People Healthy and Others Not? The Determinants of Health of Populations, New York: Aldine De Gruyter.
  • Evidence-Based Medicine Working Group, 1992, “Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine,” Journal of the American Medical Association, 268(17): 2420–2425.
  • Fischer, Enno, and Saana Jukola, 2024, “Bodies of Evidence: The ‘Excited Delirium Syndrome’ and the Epistemology of Cause-of-Death Inquiry,” Studies in History and Philosophy of Science, 104: 38–47.
  • Foucault, Michel, 1967, Madness and Civilisation: A History of Insanity in the Age of Reason, London: Tavistock.
  • –––, 1990, The History of Sexuality: An Introduction, Volume I, trans. Robert Hurley, New York: Vintage.
  • –––, 2002, The Birth of the Clinic: An Archaeology of Medical Perception, New York: Vintage.
  • Fricker, Miranda, 2007, Epistemic Injustice: Power and the Ethics of Knowing, New York: Oxford University Press.
  • Friedman, Yael, 2024, “Conceptual Scaffolding for the Philosophy of Medicine,” Medicine, Health Care and Philosophy, 28: 45–64.
  • Garson, Justin, 2019, What Biological Functions Are and Why They Matter, New York: Cambridge University Press.
  • Goldenberg, Maya J., 2006, “On Evidence and Evidence-Based Medicine: Lessons from the Philosophy of Science,” Social Science and Medicine, 62(11): 2621–2632.
  • –––, 2009, “Iconoclast or Creed? Objectivism, Pragmatism, and the Hierarchy of Evidence,” Perspectives in Biology and Medicine, 52(2): 168–187.
  • –––, 2021, Vaccine Hesitancy: Public Trust, Expertise, and the War on Science, Pittsburgh: University of Pittsburgh Press.
  • González-Moreno, María, Cristian Saborido, and David Teira, 2015, “Disease-Mongering Through Clinical Trials,” Studies in History and Philosophy of Biological and Biomedical Sciences, 51: 11–18.
  • Goodman, Kenneth W., 2002, Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science, Cambridge: Cambridge University Press.
  • Greene, Jeremy, 2006, Prescribing by Numbers: Drugs and the Definition of Disease, Baltimore: Johns Hopkins University Press.
  • Greenhalgh, Trisha, 2014, How to Read a Paper: The Basics of Evidence-Based Medicine, Oxford: John Wiley & Sons.
  • Greenhalgh, Trisha, Rosamund Snow, Sara Ryan, Sian Rees, and Helen Salisbury, 2015, “Six ‘Biases’ Against Patients and Carers in Evidence-Based Medicine,” BMC Medicine, 13: 200.
  • Hagner, Michael, 2003, “Scientific Medicine,” in Daniel Cahan (ed.), From Natural Philosophy to the Sciences: Writing the History of Nineteenth-Century Science, Chicago: University of Chicago Press, pp. 49–87.
  • Hatzenbuehler, Mark L., Jo C. Phelan, and Bruce G. Link, 2013, “Stigma as a Fundamental Cause of Population Health Inequalities,” American Journal of Public Health, 103(5): 813–821.
  • Hausman, Daniel M., 2015, Valuing Health: Well-Being, Freedom and Suffering, New York: Oxford University Press.
  • Hofmann, Bjørn, 2016, “Medicalization and Overdiagnosis: Different but Alike,” Medicine, Health Care and Philosophy, 19: 253–264. doi:10.1007/s11019-016-9693-6.
  • Hofmann, Bjørn, and Fredrik Svenaeus, 2018, “How Medical Technologies Shape the Experience of Illness,” Life Sciences, Society and Policy, 14(1): 3.
  • Hogan, Andrew J., 2019, “Moving Away from the ‘Medical Model’: The Development and Revision of the World Health Organization’s Classification of Disability,” Bulletin of the History of Medicine, 93(2): 241–269.
  • Hookway, Christopher, 2010, “Some Varieties of Epistemic Injustice: Reflections on Fricker,” Episteme, 7(2): 151–163.
  • Illich, Ivan, 1976, Medical Nemesis, New York: Random House.
  • Ioannidis, John P. A., 2016, “Evidence-Based Medicine Has Been Hijacked: A Report to David Sackett,” Journal of Clinical Epidemiology, 73: 82–86.
  • Irwin, A., and E. Scali, 2007, “Action on the Social Determinants of Health: A Historical Perspective,” Global Public Health, 2(3): 235–256.
  • Jasanoff, Sheila, Stephen Hilgartner, J. Benjamin Hurlbut, Onur Özgöde, and Margarita Rayzberg, 2021, “Comparative Covid Response: Crisis, Knowledge, Politics (Interim Report),” accessed July 2, 2025, from Harvard-Cornell Report 2020.
  • Kantor, Leslie M., and Laura Lindberg, 2020, “Pleasure and Sex Education: The Need for Broadening Both Content and Measurement,” American Journal of Public Health, 110(2): 145–148.
  • Kaplan, Jonathan M., 2019, “Self-Care as Self-Blame Redux: Stress as Personal and Political,” Kennedy Institute of Ethics Journal, 29(2): 97–123.
  • Keating, Peter, and Alberto Cambrosio, 2003, Biomedical Platforms: Realigning the Normal and the Pathological in Late-Twentieth-Century Medicine (Vol. 4), Cambridge: MIT Press.
  • Kendler, Kenneth S., 2016, “Phenomenology of Schizophrenia and the Representativeness of Modern Diagnostic Criteria,” JAMA Psychiatry, 73(10): 1082–1092.
  • Keuck, Lara, 2024, “Scope Validity in Medicine,” in Maartje Schermer and Nicholas Binney (eds.), A Pragmatic Approach to Conceptualization of Health and Disease, Philosophy and Medicine, vol. 151, Cham: Springer, pp. 115–133.
  • Kidd, Ian James, and Havi Carel, 2017, “Epistemic Injustice and Illness,” Journal of Applied Philosophy, 34(2): 172–190.
  • –––, 2018, “Healthcare Practice, Epistemic Injustice, and Naturalism,” in Simon Barker, Charlie Crerar, and Trystan Goetze (eds.), Harms and Wrongs in Epistemic Practice, Cambridge: Cambridge University Press, pp. 136–154.
  • –––, 2019, “Pathocentric Epistemic Injustice and Conceptions of Health,” in Benjamin R. Sherman and Stacey Goguen (eds.), Overcoming Epistemic Injustice: Social and Psychological Perspectives, New York: Rowman & Littlefield, pp. 153–162.
  • Kingma, Elselijn, 2014, “Naturalism About Health and Disease: Adding Nuance for Progress,” Journal of Medicine and Philosophy, 39(6): 590–608.
  • Krieger, Nancy, 2011, Epidemiology and the People’s Health: Theory and Context, New York: Oxford University Press.
  • –––, 2017, “Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100%,” American Journal of Public Health, 107(4): 541–549.
  • Krueger, James, 2015, “Theoretical Health and Medical Practice,” Philosophy of Science, 82(3): 491–508.
  • Kuhn, Thomas S., 1962, The Structure of Scientific Revolutions, Chicago: University of Chicago Press.
  • Kukla, Quill R., 2022, “What Counts as a Disease, and Why Does It Matter?” The Journal of Philosophy of Disability, 2: 130–156.
  • Kukla, Rebecca, 2014, “Performative Force, Convention, and Discursive Injustice,” Hypatia, 29(2): 440–457.
  • Laforest, David, 2020, “Health Biometrics and the Narrative Self,” Public, 30(60): 166–174..
  • Lakatos, Imre, 1968, “Criticism and the Methodology of Scientific Research Programmes,” Proceedings of the Aristotelian Society, 69: 149–186.
  • Latour, Bruno, 1987, Science in Action: How to Follow Scientists and Engineers Through Society, Cambridge, MA: Harvard University Press.
  • Lee, Keekok, 2017, The Philosophical Foundations of Classical Chinese Medicine: Philosophy, Methodology, Science, Lanham, Maryland: Lexington Books.
  • –––, 2021, “Epidemiology Is Ecosystem Science,” Synthese, 198(Suppl 10): 2539–2567.
  • Link, Bruce G., and Jo C. Phelan, 2002, “McKeown and the Idea That Social Conditions Are Fundamental Causes of Disease,” American Journal of Public Health, 92(5): 730–732. doi:10.2105/AJPH.92.5.730.
  • Lohse, Simon, and Stefano Canali, 2021, “Follow the Science? On the Marginal Role of the Social Sciences in the COVID-19 Pandemic,” European Journal for Philosophy of Science, 11(4): 99.
  • Lomborg, Stine, Henriette Langstrup, and Tariq Osman Andersen, 2020, “Interpretation as Luxury: Heart Patients Living with Data Doubt, Hope, and Anxiety,” Big Data and Society, 7(1): 2053951720924436. doi:10.1177/2053951720924436.
  • Löwy, Ilana, 2011, “Historiography of Biomedicine: ‘Bio,’ ‘Medicine,’ and In Between,” Isis, 102(1): 116–122.
  • Lupton, Deborah, 2016a, The Quantified Self: A Sociology of Self-Tracking, Cambridge: Polity Press.
  • –––, 2016b, “You Are Your Data: Self-Tracking Practices and Concepts of Data,” in Stefan Selke (ed.), Lifelogging: Digital Self-Tracking and Lifelogging—Between Disruptive Technology and Cultural Transformation, Wiesbaden: Springer, pp. 61–79.
  • Maas, Philipp, 2018, “Indian Medicine and Ayurveda,” in Alexander Jones and Liba Taub (eds.), The Cambridge History of Science, Chapter 27, Cambridge: Cambridge University Press, pp. 532–550.
  • Maglo, Koffi N., 2010, “Genomics and the Conundrum of Race: Some Epistemic and Ethical Considerations,” Perspectives in Biology and Medicine, 53(3): 357–372. doi:10.1353/pbm.0.0171.
  • –––, 2012, “Group-Based and Personalized Care in an Age of Genomic and Evidence-Based Medicine: A Reappraisal,” Perspectives in Biology and Medicine, 55(1): 137–154.
  • Malsch, Ann-Kathrin, Alexander Killin, and Matthias I. Kaiser, 2024, “Health-Oriented Environmental Categories, Individual Health Environments, and the Concept of Environment in Public Health,” Health Care Analysis, 1–24.
  • Marcum, James A., 2005, “Biomechanical and Phenomenological Models of the Body, the Meaning of Illness and Quality of Care,” Medicine, Health Care and Philosophy, 7(3): 311–320.
  • –––, 2008, “Introduction: A Philosophy of Medicine?” in Humanizing Modern Medicine: An Introductory Philosophy of Medicine, New York: Springer, pp.1-14.
  • –––, 2008, “Patient as Body or Person,” in Humanizing Modern Medicine: An Introductory Philosophy of Medicine, New York: Springer, pp. 49–61.
  • Mason, Rebecca, 2011, “Two Kinds of Unknowing,” Hypatia, 26(2): 294–307.
  • McClain, Elizabeth K., 2017, “Changes in Osteopathic Medical Education: The Journey Continues,” The Journal of the American Osteopathic Association, 117(4): 208–210.
  • McClimans, Leah, 2015, “Place of Birth: Ethics and Evidence,” Topoi, 1–8.
  • –––, 2024, Patient-Centered Measurement: Ethics, Epistemology, and Dialogue in Contemporary Medicine, Oxford: Oxford University Press.
  • McKeown, Thomas, 1976, The Role of Medicine: Dream, Mirage, or Nemesis, London: Nuffield Provincial Hospitals Trust.
  • Medina, José, 2017, “Varieties of Hermeneutical Injustice,” in Ian James Kidd, José Medina, and Gaile Pohlhaus Jr. (eds.), The Routledge Handbook of Epistemic Injustice, London: Routledge, pp. 41–52.
  • Metzl, Jonathan M., and Anna Kirkland (eds.), 2010, Against Health: How Health Became the New Morality, New York: New York University Press.
  • Midanik, Lorraine T., 2004, “Biomedicalization and Alcohol Studies: Implications for Policy,” Journal of Public Health Policy, 25: 211–228.
  • Millum, Joseph, and Ezekiel J. Emanuel (eds.), 2012, Global Justice and Bioethics, Oxford: Oxford University Press.
  • Muller, Seán M., 2021, “Masks, Mechanisms and Covid-19: The Limitations of Randomized Trials in Pandemic Policymaking,” History and Philosophy of the Life Sciences, 43(2): 43.
  • Nunn, Amy, 2009, The Politics and History of AIDS Treatment in Brazil, New York: Springer Science+Business Media.
  • Owens, John, and Alan Cribb, 2019, “‘My Fitbit Thinks I Can Do Better!’ Do Health-Promoting Wearable Technologies Support Personal Autonomy?” Philosophy & Technology, 32(1): 23–38.
  • Parsons, Annie, and Claire Hooker, 2010, “Dignity and Narrative Medicine,” Journal of Bioethical Inquiry, 7(4): 345–351.
  • Peña-Guzmán, David M., and Joel Michael Reynolds, 2019, “The Harm of Ableism: Medical Error and Epistemic Injustice,” Kennedy Institute of Ethics Journal, 29(3): 205–242.
  • Pinto, Andrew D., and Ross E. G. Upshur, 2009, “Global Health Ethics for Students,” Developing World Bioethics, 9(1): 1–10.
  • Prainsack, Barbara, 2017, Personalized Medicine: Empowered Patients in the 21st Century?, New York: NYU Press.
  • Rastogi, Sanjeev, 2014, “Ayurvedic Principles of Food and Nutrition: Translating Theory into Evidence-Based Practice,” in Sanjeev Rastogi (ed.), Ayurvedic Science of Food and Nutrition, New York: Springer, pp. 3–14.
  • Ritunnano, Rosa, 2022, “Overcoming Hermeneutical Injustice in Mental Health: A Role for Critical Phenomenology,” Journal of the British Society for Phenomenology, 53(3): 243–260.
  • Robinson, G. Canby, 1939, The Patient as a Person: A Study of the Social Aspects of Illness, New York: Commonwealth Fund.
  • Rose, Nikolas, 2007, “Beyond Medicalisation,” The Lancet, 369(9562): 700–702. doi:10.1016/S0140-6736(07)60319-5.
  • Rosenberg, Alex, 2006, Darwinian Reductionism: Or, How to Stop Worrying and Love Molecular Biology, Chicago: University of Chicago Press.
  • Sadler, John Z., Fabrice Jotterand, Simon Craddock Lee, and Stephen Inrig, 2009, “Can Medicalization Be Good? Situating Medicalization Within Bioethics,” Theoretical Medicine and Bioethics, 30(6): 411–425. doi:10.1007/s11017-009-9122-4.
  • Sidel, Victor W., and Ruth Sidel, 1981, “All Self-Care Is Not Solipsistic, but Selective Citation Surely Is: A Reply to Katz and Levin,” International Journal of Health Services, 11(4): 653–657.
  • Solomon, Miriam, 2011, “Just a Paradigm: Evidence-Based Medicine in Epistemological Context,” European Journal for Philosophy of Science, 1(3): 451–466.
  • –––, 2015, Making Medical Knowledge, New York: Oxford University Press.
  • –––, 2021, “On the Concept of ‘Psychiatric Disorder’: Incorporating Psychological Injury,” Philosophy, Psychiatry, & Psychology, 28(4): 329–339.
  • Spencer, Lucienne J., 2023, “Hermeneutical Injustice and Unworlding in Psychopathology,” Philosophical Psychology, 1–26.
  • Spencer, Lucienne J., and Havi Carel, 2021, “‘Isn’t Everyone a Little OCD?’ The Epistemic Harms of Wrongful Depathologization,” Philosophy of Medicine, 2(1): 1–18.
  • Spencer, Lucienne J., and Ian James Kidd, 2023, “‘The Hermeneutic Problem of Psychiatry’ and the Co-Production of Meaning in Psychiatric Healthcare,” Royal Institute of Philosophy Supplements, 94: 103–131.
  • Stark, John E., 2013, “An Historical Perspective on Principles of Osteopathy,” International Journal of Osteopathic Medicine, 16(1): 3–10.
  • Stegenga, Jacob, 2011, “Is Meta-Analysis the Platinum Standard of Evidence?” Studies in History and Philosophy of Biological and Biomedical Sciences, 42(4): 497–507.
  • –––, 2018, Medical Nihilism, Oxford: Oxford University Press.
  • Svenaeus, Fredrik, 2019, “A Defense of the Phenomenological Account of Health and Illness,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 44(4): 459–478.
  • –––, 2023, “The Phenomenology of Objectification in and Through Medical Practice and Technology Development,” The Journal of Medicine and Philosophy, 48(2): 141–150.
  • Szasz, Thomas, 1960, “The Myth of Mental Illness,” American Psychologist, 15(2): 113–118. doi:10.1037/h0046535.
  • –––, 2007, The Medicalization of Everyday Life: Selected Essays, Syracuse: Syracuse University Press.
  • Tabery, James, 2023, Tyranny of the Gene: Personalized Medicine and Its Threat to Public Health, New York: Knopf.
  • Tal, Eran, 2025, “Models and Measurement,” in Tarja Knuuttila, Natalia Carrillo, and Rami Koskinen (eds.), The Routledge Handbook of Philosophy of Scientific Modeling, London: Routledge, pp. 256–269.
  • Tonelli, Mark R., and Timothy C. Callahan, 2001, “Why Alternative Medicine Cannot Be Evidence-Based,” Academic Medicine, 76(12): 1213–1220.
  • Tonelli, Mark R., and Ross E. G. Upshur, 2019, “A Philosophical Approach to Addressing Uncertainty in Medical Education,” Academic Medicine, 94(4): 507–511. doi:10.1097/ACM.0000000000002512.
  • Valles, Sean A., 2018, Philosophy of Population Health: Philosophy for a New Public Health Era, Abingdon, Oxon: Routledge.
  • Vogt, Henrik, Bjørn Hofmann, and Linn Getz, 2016, “The New Holism: P4 Systems Medicine and the Medicalization of Health and Life Itself,” Medicine, Health Care and Philosophy, 19(2): 307–323. doi:10.1007/s11019-016-9683-8.
  • Vogt, Henrik, Elling Ulvestad, Thor Eirik Eriksen, and Linn Getz, 2014, “Getting Personal: Can Systems Medicine Integrate Scientific and Humanistic Conceptions of the Patient?” Journal of Evaluation in Clinical Practice, 20(6): 942–9952. doi:10.1111/jep.12251.
  • Wanderer, Jeremy, 2017, “Varieties of Testimonial Injustice,” in Ian James Kidd, José Medina, and Gaile Pohlhaus Jr. (eds.), The Routledge Handbook of Epistemic Injustice, London: Routledge, pp. 27–40.
  • Wardrope, Alistair, 2015, “Medicalization and Epistemic Injustice,” Medicine, Health Care and Philosophy, 18(3): 341–352. doi:10.1007/s11019-014-9608-3.
  • Wieten, Sarah, 2018, “Expertise in Evidence-Based Medicine: A Tale of Three Models,” Philosophy, Ethics, and Humanities in Medicine, 13(1): 2. doi:10.1186/s13010-018-0053-7.
  • Wolfe, Charles T., 2015, “Was Canguilhem a Biochauvinist? Goldstein, Canguilhem and the Project of Biophilosophy,” in Darian Meacham (ed.), Medicine and Society: New Perspectives in Continental Philosophy, Dordrecht: Springer, pp. 197–212.
  • Woods, Angela, 2011, “The Limits of Narrative: Provocations for the Medical Humanities,” Medical Humanities, 37(2): 73–78.
  • Woods, Simon, 2017, “Holism in Health Care: Patient as Person,” in Thomas Schramme and Steven Edwards (eds.), Handbook of the Philosophy of Medicine, Dordrecht: Springer.
  • Worrall, John, 2007, “Why There’s No Cause to Randomize,” The British Journal for the Philosophy of Science, 58(3): 451–488. doi:10.1093/bjps/axm024.
  • Yüksekdağ, Yusuf, 2020, “Individual Responsibilities in Partial Compliance: Skilled Health Worker Emigration from Under-Served Regions,” Public Health Ethics, 13(1): 89–98. doi:10.1093/phe/phz016.
  • Zola, Irving Kenneth, 1976, “Medicine as an Institution of Social Control,” Ekistics, 41(245): 210–214.x

Acknowledgments

We thank Robyn Bluhm and Maya Goldenberg for their comments on the original version of the entry, and Thomas Bonnin for his helpful comments on this version. We also thank the organizers and participants of “Trajectories of Epistemic Injustice in Philosophy of Medicine – A Workshop with Miranda Fricker” (Bielefeld University), especially Lara Keuck, for helpful discussions on the scope of epistemic injustice and its limitations.

Copyright © 2025 by
Sean Valles <valles@msu.edu>
Yael Friedman <yaelfriedman1@gmail.com>

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