The rise and fall of therapeutic rationality

This ProPublica story—not just the spread of disinformation about these drugs, but specifically doctors’ complicity in generating runs and shortages, endangering patients who need them for chronic diseases such as lupus—reminds me of what the physician-historian Scott Podolsky calls a “pyrrhic victory” in the battle over “therapeutic rationality” in his wonderful book The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics—which anyone interested in the history or philosophy of medical evidence should go read immediately.

Podolsky shows that in the 1970s a powerful backlash from a coalition of doctors and pharmaceutical companies against the FDA’s new power to regulate drugs helped ensure we have no robust, centralized public oversight of prescription practices. (If you’re surprised to see doctors opposing what you think of as the public good, you’ll be even more surprised to read about their opposition to universal health insurance in Paul Starr’s The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry.)

Here’s how Podolsky puts it:

The limits to government encroachment on the prescribing of antibiotics in the United States would be reached with Panalba and the fixed-dose combination antibiotics. While the FDA had been empowered to remove seemingly ‘irrational’ drugs from the marketplace, no one had been empowered to rein in the seemingly inappropriate prescribing of appropriate drugs. The 1970s would witness ongoing professional and government attention given to the increasingly quantified prevalence of ‘irrational’ antibiotic prescribing and its consequences, and such attention would in fact lead to attempts to restrain such prescribing through both educational and regulatory measures. The DESI process, though, had generated a vocal backlash against centralized attempts to further delimit individual antibiotic prescribing behavior in the United States, resulting in generally failed attempts to control prescribing at local, let alone regional or national, levels in the United States.

In the case of antibiotics, the result has been decades of promiscuous prescription, as overuse of antibacterials helped to breed a new generation of antibiotic-resistant “superbugs”—at the very same time that pharmaceutical companies, deciding that these drugs weren’t profitable, stopped trying to develop new ones. We thus have very few antibiotics to take the place of the ones that no longer work, even though isolated voices have been sounding the alarm all along—just as others have regarding pandemics. (Obama’s administration not only put in place a pandemic response team that Trump’s administration dismantled. It also developed a “National Action Plan for Combating Antibiotic-Resistance Bacteria.”) This is maybe the least familiar massive negative market externality of our time. Another result of such promiscuous prescription is much better known: we call it the opioid crisis.

However you view the FDA today—emblem of consumer protection or bureaucratic mismanagement, regulatory capture or government barrier to innovation, success story or failure—there is no question that public oversight of drugs is important and that it is high time to rethink how we regulate prescriptions, too.

That unto logik hadde longe y-go

Two weeks ago I read Charles Homer Haskins’s slim volume The Rise of Universities (1923), a charming collection of three lectures—”The Earliest Universities,” “The Mediaeval Professor,” “The Mediaeval Student”—on the birth of universities, especially at Bologna and Paris.

I came to Haskins to get my bearings after the disorientation of discovering, while skimming David Bressoud’s new book Calculus Reordered, that the history of science took an important step forward as early as the early 1300s—centuries before Galileo, et al.—when William Heytesbury and colleagues at Merton College in Oxford clarified the relationship between kinematics and dynamics, giving the first purely mathematical treatment of motion. (Heytesbury’s most important work, the Regulae solvendi sophismata—Rules for Solving Sophisms—seems not to have been translated in full into English.) The dark ages were not quite so dark, after all. Clifford Truesdell sums up the contributions of these so-called Oxford Calculators in his Essays in the History of Mechanics:

The now published sources prove to us, beyond contention, that the main kinematical properties of uniformly accelerated motions, still attributed to Galileo by the physics texts, were discovered and proved by scholars of Merton college. […] In principle, the qualities of Greek physics were replaced, at least for motions, by the numerical quantities that have ruled Western science ever since. The work was quickly diffused into France, Italy, and other parts of Europe. Almost immediately, Giovanni di Casale and Nicole Oresme found how to represent the results by geometrical graphs, introducing the connection between geometry and the physical world that became a second characteristic habit of Western thought.

Contrary to the received image of abortive medieval scholasticism, Haskins paints a portrait of rich intellectual ferment, drawing a great deal more continuity with the present than we usually assume [cf. the dispute over the so-called “continuity thesis” in the history of science]:

The occasion for the rise of universities was a great revival of learning, not that revival of the fourteenth and fifteenth centuries to which the term is usually applied, but an earlier revival, less known though in its way quite as significant, which historians now call the renaissance of the twelfth century. So long as knowledge was limited to the seven liberal arts of the early Middle Ages, there could be no universities, for there was nothing to teach beyond the bare elements of grammar, rhetoric, logic, and the still barer notions of arithmetic, astronomy, geometry, and music, which did duty for an academic curriculum. Between 1100 and 1200, however, there came a great influx of new knowledge into western Europe, partly through Italy and Sicily, but chiefly through the Arab scholars of Spain—the works of Aristotle, Euclid, Ptolemy, and the Greek physicians, the new arithmetic, and those texts of the Roman law which had lain hidden through the Dark Ages. In addition to the elementary propositions of triangle and circle, Europe now had those books of plane and solid geometry which have done duty in schools and colleges ever since; instead of the painful operations with Roman numerals—how painful one can readily see by trying a simple problem of multiplication or division with these characters—it was now possible to work readily with Arabic figures; in the place of Boethius, the “Master of them that know” became the teacher of Europe in logic, metaphysics, and ethics. In law and medicine men now possessed the fullness of ancient learning. This new knowledge burst the bonds of the cathedral and monastery schools and created the learned professions; it drew over mountains and across the narrow seas eager youths who, like Chaucer’s Oxford clerk of a later day, “would gladly learn and gladly teach,” to form in Paris and Bologna those academic gilds which have given us our first and our best definition of a university, a society of masters and scholars.

Later in the book, Haskins notes that this renaissance

added to the store of western knowledge the astronomy of Ptolemy, the complete works of Euclid, and the Aristotelian logic, while at the same time under the head of grammar great stimulus was given to the study and reading of the Latin classics. This classical revival, which is noteworthy and comparatively little known, centered in such cathedral schools as Chartres and Orleans, where the spirit of a real humanism showed itself in an enthusiastic study of ancient authors and in the production of Latin verse of a really remarkable quality. Certain writings of one of these poets, Bishop Hildebert of Le Mans, were even mistaken for “real antiques” by later humanists. Nevertheless, though brilliant, this classical movement was short-lived, crushed in its early youth by the triumph of logic and the more practical studies of law and rhetoric. In the later twelfth century John of Salisbury inveighs against the logicians of his day, with their superficial knowledge of literature; in the university curriculum of the thirteenth century, literary studies have quite disappeared. Toward 1250, when a French poet, Henri d’Andeli, wrote his Battle of the Seven Arts, the classics are already the ancients, fighting a losing battle against the moderns:

Logic has the students,
Whereas Grammar is reduced in numbers.
Civil Law rode gorgeously
And Canon Law rode haughtily
Ahead of all the other arts.

If the absence of the ancient classics and of vernacular literature is a striking feature of the university curriculum in arts, an equally striking fact is the amount of emphasis placed on logic or dialectic. The earliest university statutes, those of Paris in 1215, require the whole of Aristotle’s logical works, and throughout the Middle Ages these remain the backbone of the arts course, so that Chaucer can speak of the study of logic as synonymous with attendance at a university—

That un-to logik hadde longe y-go.

In a sense this is perfectly just, for logic was not only a major subject of study itself, it pervaded every other subject as a method and gave tone and character to the mediaeval mind. Syllogism, disputation, the orderly marshalling of arguments for and against specific theses, these became the intellectual habit of the age in law and medicine as well as in philosophy and theology. The logic, of course, was Aristotle’s, and the other works of the philosopher soon followed, so that in the Paris course of 1254 we find also the Ethics, the Metaphysics, and the various treatises on natural science which had at first been forbidden to students. To Dante Aristotle had become “the Master of them that know,” by virtue of the universality of his method no less than of his all-embracing learning. “The father of book knowledge and the grandfather of the commentator,” no other writer appealed so strongly as Aristotle to the mediaeval reverence for the text-book and the mediaeval habit of formal thought. Doctrines like the eternity of matter which seemed dangerous to faith were explained away, and great and authoritative systems of theology were built up by the methods of the pagan philosopher. And all idea of literary form disappeared when everything depended on argument alone.

The cultural Cold War

Jamie Cohen-Cole, The Open Mind: Cold War Politics and the Sciences of Human Nature (2014)

Greg Barnhisel, Cold War Modernists: Art, Literature, and American Cultural Diplomacy (2015)

Loren Graham, Science in Russia and the Soviet Union: A Short History (1993)

Sarah Miller Harris, The CIA and the Congress for Cultural Freedom in the Early Cold War (2016)

John Krige, American Hegemony and the Postwar Reconstruction of Science in Europe (2006)

Stuart W. Leslie, The Cold War and American Science: The Military-Industrial-Academic Complex at MIT and Stanford (1993)

Christopher J. Phillips, The New Math: A Political History (2014)

Carroll Pursell, Technology in Postwar America: A History (2007)

Gregory A. Reisch, How the Cold War Transformed Philosophy of Science: To the Icy Slopes of Logic (2005)

Giles Scott-Smith, The Politics of Apolitical Culture (2016)

Valery N. Soyfer, Lysenko and the Tragedy of Soviet Science (1994)

Frances Stonor Saunders, The Cultural Cold War: The CIA and the World of Arts and Letters (1999)

Jessica Wang, American Science in an Age of Anxiety: Scientists, Anticommunism, and the Cold War (1999)

Duncan White, Cold Warriors: Writers Who Waged the Literary Cold War (2019)

Stephen J. Whitfield, The Culture of the Cold War (1991)

Hugh Wilford, The Mighty Wurtlizter: How the CIA Played America (2008)

Audra J. Wolfe, Freedom’s Laboratory: The Cold War Struggle for the Soul of Science (2018)

Audra J. Wolfe, Competing with the Soviets: Science, Technology, and the State in Cold War America (2013)

Mechanism in biology

William Bechtel, Discovering Cell Mechanisms: The Creation of Modern Cell Biology (2006)

William Bechtel, “Mechanism and Biological Explanation,” Philosophy of Science (2011)

William Bechtel, “Biological Mechanisms: organized to maintain autonomy,” in Systems Biology: Philosophical Foundations (2007)

Carl Craver and James Tabery, “Mechanisms in Science,” Stanford Encyclopedia of Philosophy (2015)

Carl F. Craver and Lindley Darden, In Search of Mechanisms: Discoveries Across the Life Sciences (2013)

Margaret Gardel, “Moving beyond molecular mechanisms,” Journal of Cell Biology (2015)

Daniel J. Nicholson, “The concept of mechanism in biology,” Studies in History and Philosophy of Biological and Biomedical Sciences (2012)

Rob Phillips, “Musings on mechanism: quest for a quark theory of proteins?” Journal of the Federation of American Societies for Experimental Biology (2017)

James Tabery, Monika Piotrowska, and Lindley Daren, “Molecular Biology,” Stanford Encyclopedia of Philosophy (2015)

Quite an everyday occurrence

from Huygens and Barrow, Newton and Hooke, Vladimir Arnold, translated by Eric J. F. Primrose (1989):

Hooke was a poor man and began work as an assistant to Boyle (who is now well known thanks to the Boyle-Mariotte law discovered by Hooke). Subsequently Hooke began working in the recently established Royal Society (that is, the English Academy of Sciences) as Curator. The duties of the Curator of the Royal Society were very onerous. According to his contract, at every session of the Society (and they occurred every week except for the summer vacation) he had to demonstrate three or four experiments proving the new laws of nature.

Hooke held the post of Curator for forty years, and all that time he carried out his duties thoroughly. Of course, there was no condition in the contract that all the laws to be demonstrated had to be devised by him. He was allowed to read books, correspond with other scientists, and to be interested in their discoveries. He was only required to verify whether their statements were true and to convince the Royal Society that some law was reliably established. For this it was necessary to prove this law experimentally and demonstrate the appropriate experiment. This was Hooke’s official activity.


At that time it was easy to carry out fundamental discoveries, and large numbers of them were carried out. Huygens, for example, improved the telescope, looked at Saturn and discovered its ring, and Hooke discovered the red spot on Jupiter. At that time discoveries were not unusual events, they were not registered, not patented, as they are now, they were quite an everyday occurrence. (This was the case not only in the natural sciences. Mathematical discoveries at that time also poured forth as if from a horn of plenty.)

But Hooke never had enough time to dwell on any of his discoveries and develop it in detail, since in the following week he needed to demonstrate new laws. So in the whole manifold of Hooke’s achievements his discoveries appeared somewhat incomplete, and sometimes when he was in a hurry he made assertions that he could not justify accurately and with mathematical rigour.


Holding the chair at Cambridge, Newton earned considerably more (200 pounds a year), and the farm that he had inherited, which he leased out and where the famous apple tree grew, gave him roughly the same income. Despite the fact that Newton was quite well off, he did not want to spend any money on the publication of the book, so he sent the Principia to the Royal Society, which decided to publish the book at its own expense. But the Society had no money, so the manuscript lay there until Halley (who was the son of a rich soap manufacturer) published it on his own account. Halley took on himself all the trouble of publishing the book, and even read the proofs himself. Newton, in correspondence at this time, called it “Your book”…