Review of NKCC

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search that addresses the individual and complex nature of medical decision making, as well as to the ethical implications of patient-centered care. Any investigation of EBM has to balance respect for the movement’s ability to promote internal critical investigation into potentially harmful practices with an appreciation for the limitations of EBM as a comprehensive basis for medical decisions. Daly manages to walk this line throughout the book, erring, when she does err, on the side of charity in interpreting the claims of EBM. Even with this charitable reading, Daly draws a number of important conclusions about the conceptual and practical boundaries of EBM. Daly’s comprehensive account of recent developments in the history of medicine fills a gap in the existing literature. Her investigation complements the more critical social/political work by Stefan Timmermans and Marc Berg in The Challenge of Evidence-Based Medicine and Standardization in Health Care (Temple, 2003) and the philosophical analysis by Kenneth Goodman in Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science (Cambridge, 2003). The overriding message of Daly’s book is the importance of the “right people” to the project of reforming medicine. More specifically, her account is largely a history of the achievements of “great men.” While Daly openly acknowledges the near-absence of women in this recent medical history, she does not provide any extensive discussion of why this is the case. Further work on this point seems warranted. Nonetheless, whether it is David Sackett’s charisma and ability to attract and engage “brilliant young minds” (p. 76), Alvan Feinstein’s “pen dipped in acid” (p. 240), or Archie Cochrane’s insistence that fellow clinicians provide an answer to the question, “Have you any evidence for that?” (p. 140), the face of medicine has changed because these powerful figures found a way to engage researchers and practitioners, challenge orthodox views, and propose new methods. With Evidence-Based Medicine and the Search for a Science of Clinical Care, Daly contributes to our understanding of the ways in which medical and scientific theories are developed and promulgated not solely, or even primarily, on the basis of evidence. As we see through her interviews and candid discussions with the leaders of EBM, change occurs as a result of charisma, rhetorical skill, and the careful creation of intensive communities of like-minded scholars—even when advancing an approach that is “evidence based.” KIRSTIN BORGERSON

Joseph LaPorte. Natural Kinds and Conceptual Change. x Ⳮ 221 pp., notes, refs., index. Cambridge: Cambridge University Press, 2004. $70 (cloth). At one time—mostly in the nineteenth century—we could speak quite easily about species as natural kinds. They were the paradigmatic example. Time passed. For most of the twentieth century, our paradigmatic example of natural kinds (and the related problem of essences) came from physics. Unquestionably, kinds in physics seemed to be defined by common essences, embedded in natural laws and explanatory nexa as told in the stories of the logical positivists. This is what the philosophers of biology and biologists Ernst Mayr and David Hull worried about. Both resisted physics envy in biology, and both were highly influential in overthrowing any talk about species as natural kinds, inoculating the philosophy of biology from any kind of kindtalk. The former put his hopes on the replacement “populational thinking,” turning away from essentialism and what he called “typology.” The latter turned away from natural kinds to “causal individuals” and, regrettably, opened up the interminable debate about species as individuals. Philosophers of biology have generally faced their way ever since. Joseph LaPorte wants to resurrect positive talk about natural kinds and insert it into general discussions of theory and meaning change and associated problems of reference in science. Natural Kinds and Conceptual Change, based on a 1998 dissertation at the University of Massachusetts, is a closely argued defense of the notion of species as natural kinds. His paradigmatic examples come unabashedly from biology. For him, species can have essences. The book will be enjoyed with great profit by both philosophers and historians of science as one of the clearest and most original contributions to this topic in quite some time. Philosophers of biology (and general philosophers of science and meaning) will find much to chew on. LaPorte takes an unpopular (but I think quite defensible) stand against the received view of Saul Kripke and Hilary Putnam (that conclusions about essences are discovered to be true). In recent years, historians of biology (when they have taken any notice) have found some loose affinity with the Kripkean view of naming and necessity, at least its notion of a causal theory of meaning. In identifying and naming of a type specimen without a uniquely identifying description, a unique and causal relationship is established with the initial dubbing,

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held together by a common intersubjective communicating community, divided in its labor between the dubbers and the communicators. This indeed looks something like William Whewell’s original use of the term “natural kind,” where, for example, an initial dubbing gave a core referent around which myriad theoretical beliefs could play freely. (That is how the British Museum once solved its own problem of authority in the nineteenth century.) But the causal theory had a little lump unpalatable to most historians (and sociologists) still proud of their methodological pluralism and their indexicality. The causal theory still required an “essence” that was discovered to be true. Kripke and Putnam still talked of essences and of “progress.” Here recent historians resisted the Kripke/Putnam holy grail—the ultimate essence—and thought more along Kuhnian lines. LaPorte is none too keen on abandoning essentialism outright, yet he has no wish to return to either the positivist story or the Kripke/Putnam countermeasures against Kuhn. LaPorte relies for his inspiration on some fine work done by historians of biology. In a famous pair of articles in the 1980s, my now– fellow Canadian John Beatty showed that Darwin’s revolution could have gone either way with respect to meaning and kinds: either accepting the initial dubbing of species and changing the meaning, or keeping the meaning and drubbing the dubbing. LaPorte’s book acknowledges its debt to Beatty’s work and shows a way out. LaPorte is unabashed and unorthodox: species are indeed natural kinds. Species have essences, but members do not essentially belong to a kind. His main thesis turns around this: that speakers’ entrenched judgments about what belongs in the extension of a term are not subject to empirical refutation. Rather, we witness a replacement of an older, less precise, use of the word with a newer, more sophisticated, one. Hence progress. In several closely reasoned chapters, LaPorte dissects the various implications and alternatives built on the Kripke/Putnam model (alas, this part does read like a thesis), bringing a few case studies in the history of biology to bear on his own view of precision in meaning. Now, LaPorte’s view might be right, but it will take a lot more historical work to decide if this is the case—or whether it can be expanded into a general theory of reference and natural kinds. LaPorte is generally better than some philosophers of biology when it comes to the history. But we have to be careful. For example, LaPorte repeats the common notion that there was a strict definitional meaning of the species

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category (and related taxon) in the pre-Darwinian literature and that Darwin changed the meaning of species. Recent historical research has shown that this was not the case. Yet historians and philosophers will benefit from LaPorte’s reasonable and measured removal of many of the horrors associated with these terms “essence” and “natural kind.” Some biologists might resist his overemphasis on evolutionary/historical explanations as the implied true meaning of biology, although his pluralism and sliding scale of naturalness might strike a chord. Historians of biology will still want for a good robust encounter with the history of “natural kinds.” For it is in the life sciences that we find the birth and historical development of this term. GORDON MCOUAT Dominique Pestre. Science, argent et politique: Un essai d’interpre´tation. 201 pp., bibl. Paris: INRA, 2003. Dominique Pestre is a professional historian of twentieth-century French physics and director of the Centre Alexandre Koyre´ in Paris. But Science, argent et politique: Un essai d’interpre´tation, historically informed as it is, is not about the history of science but about what may today be happening as what Pestre calls the “re´gime de savoir” that characterized the twentieth century is progressively dismantled. Pestre weaves together many threads. He puts into historical perspective successive re´gimes de savoir—that is, configurations of judgments as to what counts as science and as scientific, the role and social environment of scientists, and the role and functioning of sciences with regard to politics and economics. He critiques the sociological model of the new mode of scientific knowledge production, a model associated with Helga Nowotny, Peter Scott, and Michael Gibbons (Re-thinking Science: Knowledge and the Public in an Age of Uncertainty [Polity, 2001]). Finally, he discusses why the contemporary situation should be a matter for deep concern for us as citizens. Pestre’s criticism of the distinction proposed by Nowotny, Scott, and Gibbons between two modes of the production of scientific knowledge serves as a bridge between history and social commentary. Their characterization of the first mode—centered on academics and valuing autonomy and peer evaluation—corresponds, Pestre charges, to an idealized image forged about 1870. In this era, a new re´gime de savoir began; it was characterized by intense relations between