What's Really Going On When You Go to the Doctor? The Philosophy of Biomedicine

Imagine you wake up with a terrible stomach ache. Your parent takes you to the doctor. The doctor asks some questions, presses on your belly, and then sends you to a lab where a technician takes some blood. A few days later, you’re back in the office, and the doctor says: “Your blood work shows you have an infection. Here’s a prescription for antibiotics.”

Now imagine that instead, your grandmother gives you a cup of herbal tea and tells you a story about how your stomach is “out of balance” with the seasons. She might be right that you’ll feel better. But if you ask why the tea works, she’d give you a very different kind of answer than the doctor would.

This is the puzzle at the heart of this article: What kind of knowledge is medical knowledge? Is it just biology applied to people? Or is something else going on?

The Biomedical View: Your Body Is a Machine

The standard approach to medicine in most wealthy countries today is called biomedicine. If you’ve ever been to a doctor, you’ve experienced it. Here’s what it assumes:

Disease is a biological, chemical, or physical problem. If something’s wrong with you, it’s because some part of your body isn’t working right at the molecular level. There’s no spirit, no bad energy, no cosmic imbalance—just cells, chemicals, and physical processes that went haywire.
The best way to figure out what’s wrong is through laboratory research and controlled experiments. The gold standard is something called a “randomized controlled trial”—where you give one group of patients a treatment, another group a fake treatment (a placebo), and compare what happens. Doctors are supposed to follow the results of these trials rather than just relying on their own hunches or what older doctors told them.
The best way to explain disease is by looking at smaller and smaller parts. This is called reductionism—the idea that you understand something complicated by breaking it down into its pieces. A stomach ache isn’t really a stomach ache; it’s a particular kind of bacteria disrupting the cells lining your stomach, which changes the chemical signals those cells send, which triggers your immune system, etc.

This framework has been incredibly successful. Penicillin—a drug made from mold that kills bacteria—saved millions of lives. Vaccines created using this approach have wiped out smallpox. The COVID-19 vaccines were designed in just two days using this framework and rolled out to millions of people within a year.

But here’s the thing: biomedicine didn’t always exist. It’s a relatively recent invention, less than a hundred years old as a complete system. Before it, people in the West believed in something called “humoral theory”—the idea that health came from balancing four fluids in your body (blood, phlegm, yellow bile, and black bile), which were connected to the seasons, the planets, and even your personality. You might think that sounds silly now, but it guided medical practice for over 2,000 years.

And biomedicine isn’t the only game in town today. Traditional Chinese Medicine treats the body as a whole system of flowing energy (called “qi”), not as a collection of parts. Ayurvedic medicine, which developed in South Asia, gives different dietary advice to two people of the same age and sex based on their unique body type and even the time of day.

So the question isn’t “Is biomedicine true?”—it’s more interesting than that. The question is: What does biomedicine leave out, and should we care?

What Gets Lost When You See the Body as a Machine

One philosopher, Alex Broadbent, uses the phrase “biological chauvinism” to describe biomedicine’s refusal to consider causes of disease that aren’t biological. If you’re sick because your school is stressful, or because your family can’t afford healthy food, or because you’re being bullied—those causes don’t show up in a blood test. Biomedicine treats them as irrelevant or as things that just “complicate” the real biological problem.

But that’s weird, isn’t it? If you’re stressed and can’t sleep, and that weakens your immune system, and then you get sick—the stress is part of the cause. But biomedicine wants to focus on the virus, not the stress.

This gets even trickier when we talk about health itself. The World Health Organization once defined health as “complete physical, mental, and social well-being”—not just the absence of disease. That sounds nice, but what does it actually mean? How do you measure “social well-being” in a lab? How do you run a randomized controlled trial on happiness?

Most biomedical researchers quietly ignore that definition and focus on treating specific diseases instead. This works well for clear-cut problems like bacterial infections. But for chronic conditions like depression, chronic pain, or even diabetes, the situation is messier. These conditions involve a person’s whole life—their environment, their relationships, their habits—not just some broken part inside them.

The Problem with “Evidence-Based” Medicine

You might have heard the phrase “evidence-based medicine.” It sounds good—who wants medicine that isn’t based on evidence? But the debate is really about which evidence counts.

Here’s an example. For years, doctors debated whether people with minor back pain should take ibuprofen, acetaminophen, use heat packs, or exercise. The old way of settling this was to get a bunch of senior doctors in a room and have them argue it out. The new “evidence-based” way is to run experiments: take 100 people with back pain, randomly give half ibuprofen and half acetaminophen, and measure who feels better.

This sounds more scientific. But there’s a problem: experiments only measure what they measure. If the study only asks “how much does your back hurt?” on a 1-10 scale, it might miss that people taking ibuprofen had more stomach problems, or that their sleep improved even though their back didn’t, or that they just felt more in control.

And here’s a deeper worry: the companies that make the drugs often pay for these experiments. If you’re a drug company, you can design the experiment in ways that make your drug look good—choose a weak comparison treatment, measure only the outcomes your drug affects, stop the study early if results look favorable. Philosopher Jacob Stegenga calls this “medical nihilism”—the view that we should have much less confidence in medical treatments than we do, because the evidence is often manipulated or misleading.

Does Disease Actually Exist?

This might sound like a strange question, but philosophers spend a lot of time on it. What makes something a disease rather than just a difference?

One of the most influential answers comes from philosopher Christopher Boorse, who says disease is simply a statistically unusual failure of some body part to do its job. Your heart’s job is to pump blood; if it’s pumping at 30% of normal efficiency, that’s a disease. Your legs’ job is to walk; if they can’t, that’s a disease.

But hang on—who says legs are supposed to walk? Evolution doesn’t have goals. Your legs didn’t come with an instruction manual. And if we define disease as “not working the way most people work,” then being left-handed would have been a disease in a world where everyone was forced to use their right hand.

This matters a lot for how we think about disability. If you’re born without legs, is that a disease? Many disability activists say no—it’s a different way of being in the world. The problem isn’t your body; it’s that the world is built for people with legs. The “medical model” of disability treats your body as broken and in need of fixing. The “social model” says society is broken for not accommodating different bodies.

Both views have something right. The hard question is: how do we decide which differences are genuine problems and which are just differences that society has made into problems?

When Medicine Becomes Control

Biomedicine isn’t just a set of ideas—it’s also a massive institution with money, power, and influence. This has some troubling consequences.

Consider medicalization—the process of turning ordinary human experiences into medical conditions. Grief used to be something you just went through. Now there’s a proposed diagnosis for “complicated grief.” Shyness became “social anxiety disorder.” Being very focused on tasks became “attention deficit disorder.” Some of these changes help people get treatment they need. But some of them turn normal human variation into problems that require pharmaceutical solutions.

Then there’s the colonial dimension. When Western medicine spread around the world, it often actively suppressed local healing traditions. Indigenous healers were called frauds. Traditional Chinese Medicine was dismissed as superstition. This wasn’t just a loss of knowledge—it made poor countries dependent on rich countries for their medical training, drugs, and equipment. (To this day, many doctors from developing countries are trained in the West and then never return home.)

And during COVID-19, we saw how biomedical thinking shaped the response. The problem was defined as a biological virus that needed a biomedical solution (vaccines). This was incredibly successful in one sense—vaccines were developed at record speed. But it also meant that social solutions—improving housing conditions, reducing workplace exposure, providing paid sick leave—were treated as less important. The result? Wealthy countries hoarded vaccines while poorer countries got barely any.

Alternatives to Biomedicine

Not everyone thinks biomedicine should be the whole story. Some philosophers argue for a humanistic medicine that starts with the patient’s story, not with their lab results. If you’re depressed, it matters what happened to you, what you care about, what you’ve lost—not just your serotonin levels.

Others advocate for gentle medicine—the idea that we should intervene less, not more. Most minor illnesses get better on their own. Many treatments have side effects that are worse than the original problem. Maybe the default should be: don’t treat unless the evidence is really strong.

And some point to the population health framework, which says that the biggest improvements in human health have come not from doctors or drugs, but from clean water, better nutrition, safer workplaces, and less poverty. From this perspective, the best way to make people healthier is to change society, not to change individual bodies.

Where This Leaves Us

Here’s the honest truth: philosophers still argue about almost everything in this article. Nobody has settled what health really is, whether disease is an objective fact or a social judgment, or how much we should trust medical evidence.

What we can say is this: biomedicine has been remarkably good at solving certain kinds of problems—especially acute infections and surgical emergencies. But it’s much less good at dealing with chronic conditions, mental health, or the social causes of disease. And its success has given it a kind of authority that sometimes crowds out other ways of thinking about health.

The next time you’re in a doctor’s office, you might notice: the doctor is operating within a very specific framework that makes certain things visible and other things invisible. They can see your white blood cell count. They might not see that you’re scared, or that your family is going through a rough time, or that your school has toxic mold in the walls.

Biomedicine is powerful. But it’s not the whole story. And the fact that we can even have this conversation—that we can ask whether the way we do medicine makes sense—is what philosophy is for.

Appendices

Key Terms

Term	What it does in this debate
Biomedicine	The dominant framework that treats disease as a biological problem and medical knowledge as applied biology
Reductionism	The strategy of explaining complex things (like disease) by breaking them into smaller parts (like molecules)
Biological chauvinism	The tendency to ignore non-biological causes of disease, even when they matter
Medicalization	The process of turning ordinary human experiences (grief, shyness) into medical conditions
Evidence-based medicine	The movement to base medical decisions on controlled experiments rather than on doctors’ hunches or traditions
Medical nihilism	The skeptical view that we should have much less confidence in medical treatments than we usually do

Key People

Alex Broadbent – A philosopher who coined the term “biological chauvinism” to describe biomedicine’s narrow focus on biological causes.
Christopher Boorse – A philosopher who argued that disease is simply a part of the body failing to do its “normal” job, defined statistically.
Jacob Stegenga – A philosopher who argues for “gentle medicine” and warns that much medical evidence is unreliable (medical nihilism).
Nancy Krieger – A public health researcher who identified three core assumptions of biomedicine: biological causes, lab evidence, and reductionism.

Things to Think About

If you could design a medical system from scratch, what would you keep from biomedicine and what would you change? Would you want your doctor to know about your life, your stress, your family—or just your symptoms and lab results?
Think of something that used to be considered normal but is now treated as a medical problem (shyness, grief, being very active as a child). Is this a good thing or a bad thing? How would you decide?
What would it mean to truly take “social well-being” seriously as part of health? If poverty makes people sick, is the solution a new drug or a new economic policy? If both, how should we decide where to put our effort?
When should you trust your own experience of your body over what a doctor tells you? When should you trust the doctor instead? What makes this decision so hard?

Where This Shows Up

School health class might teach you about nutrition, but it probably doesn’t teach you that what makes people healthy is mostly having enough money, safe housing, and not being stressed all the time.
Social media is full of wellness advice that sometimes challenges biomedicine (natural remedies) and sometimes extends it (self-tracking apps, DNA testing). The question “who should I trust?” is everywhere.
News coverage of COVID-19 showed the tension between biomedical solutions (vaccines) and social solutions (paid sick leave, better ventilation in schools). Countries chose different paths based on how they understood the problem.
Disability rights movements argue that society, not individual bodies, is what needs to be “fixed” in many cases—a direct challenge to the biomedical model’s focus on individual treatment.