Medizin und Wissenschaftstheorie: Die Geschichte der Wismuttherapie als wissenschaftstheoretische Fallstudie (review)

This book is in part a contribution to the history of therapeutics, and in part a reflection on the usefulness of Thomas Kuhn’s and Ludwik Fleck’s views of science for medicine today. Starting with the earliest treatment of gastric ulcers with bismuth, the author meticulously traces the ups and downs of this therapy and relates its application to the different etiological and pathophysiological theories. Thus the decline of bismuth therapy in the second half of the nineteenth century is attributed to (among other things) the predominance of etiological thinking at that time: the more or less empirically based bismuth therapy no longer complied to the prevailing standard. After another period of popularity following the turn of the century, bismuth became, from 1920 to 1945, more and more obsolete: the new functional systemic approach in medicine diminished the attractiveness of a therapy that was seen as acting locally. From 1945 to 1983 the causation of gastric ulcers was explained by an imbalance between protective and aggressive factors, particularly gastric acid; during this time bismuth was still used but was mostly regarded as outmoded. From 1983 onward, a paradigm shift occurred: bacteria were now regarded as the primary cause of gastric ulcers, and bismuth was reintroduced as the appropriate antibiotic.

Most of this historical account is interesting and informative; the explanations are astute and often convincing. But the aim of demonstrating the usefulness of Kuhn’s and Fleck’s Wissenschaftstheorie for today’s physicians has obviously kept the author from a deeper and more historically informed study of his subject. He seems to be mainly concerned with finding out why earlier investigators failed to discover bacterial infection as the true cause of gastric ulcers; consequently, he is too preoccupied with present standards to take the contempory views seriously enough. For the history of science and medicine, however, a more thorough description and analysis of how physicians and scientists came to accept or reject certain evidence at their particular time would have been more to the point, especially since the history of therapeutics lends itself so well to a more integrated view of medical science as a cultural and social phenomenon. Instead of taking up the many clues his topic offers, the author takes “social-psychological” or “social-political factors” (pp. 176–77) as being responsible for irrationality in medical science, whereas rationality is attributed to science proper. He employs Kuhn’s term “paradigm” to describe the social-psychological attachment to a certain theory or school that leads scientists to miscomprehend or disregard even the most obvious facts (p. 188). This approach obviously prevents a more adequate understanding of the historical actors’ own rationalities.

The general theoretical conclusion of this book is that there is more irrationality in science than scientists (and philosophers) admit, and thus a knowledge of Kuhn and Fleck may be useful in helping practicing medical scientists to cope better with the irrationalities of their field. But this general conclusion does not do justice to Kuhn and Fleck, nor is it particularly exciting after the discussions in this field during the past twenty years. The study could have profited from a less present-centered approach—informed, for instance, by the discussions in Science Studies. Nevertheless, it provides a good overview of how gastric ulcers were explained and treated in history, and how they were conceived as disease entities. With its theoretical claims, however, Medizin und Wissenschaftstheorie reflects the scholarly concerns of the 1960s more than those of the 1990s.