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Rethinking the nature of medicine: limits of the inquiry thesis through the case of African traditional medicine

PMCID: PMC12583263

PMID: 41037080

Abstract

This paper critically evaluates Alex Broadbent’s Inquiry Thesis, which defines medicine by the core competencies of prediction and understanding. While the thesis seeks to avoid parochialism by identifying features that could apply across traditions, its applicability falters when examined against African traditional medicine (ATM). Using ATM as a test case, this paper demonstrates that legitimate medical systems can operate coherently and enjoy broad social legitimacy without consistently exercising prediction or understanding in Broadbent’s sense. This challenges the Inquiry Thesis both as a general account of medicine and as an inclusive framework. Accordingly, this paper tentatively advances a Refined Curative Thesis (RCT), which shifts the unifying criterion from competencies to aims: medicine is defined as the organized, socially recognized effort to restore or maintain health through interventions directed at beneficial change. RCT accommodates epistemic diversity, preserves conceptual discipline, and avoids collapsing into unstructured pluralism. By centring the curative aim, this revised account offers a more inclusive, philosophically robust, and culturally sensitive definition of medicine. The analysis deepens philosophical understanding of medicine while also bearing practical significance for global health policy, intercultural dialogue, and the recognition of diverse medical systems.

Full Text

Alex Broadbent has recently reignited philosophical debate by asking, somewhat provocatively, why so little attention has been paid to the foundational question of what medicine is [1–3]. While much has been written about medical ethics, epistemology, and methodology, Broadbent contends that the very nature of medicine itself has been comparatively neglected. I largely agree with this observation. His claims have sparked significant discussion [4–9], drawing attention to questions about medicine’s aims, its epistemic capacities, and its nature.
Broadbent positions himself against the traditional and what might fairly appear intuitive, the “Curative Thesis,” which holds that the ability to cure is an essential defining feature  of the nature of medicine. Instead, he advances the “Inquiry Thesis,” according to which medicine’s defining features are its competencies of prediction and understanding [1, 2]. This move is meant to make the definition less parochial, avoiding a model that privileges only Western biomedicine by identifying competencies that could, in principle and practice, be shared across medical traditions [2].
This paper examines this tension through a sustained case study of ATM. The choice of ATM is not incidental: it remains a major medical system for millions of people in sub-Saharan Africa. Particularly in Southern Africa, surveys suggest that up to 80% of the Black South African population consults traditional healers [10, 11]. ATM is not merely a set of spiritual or cultural practices; it is recognized under national health regulations in South Africa and elsewhere as a legitimate part of the health sector [12]. For this reason, ATM offers a valuable test case for evaluating whether Broadbent’s account can truly encompass global medical diversity.
Broadbent’s recent work has revitalized discussion on the fundamental question of the nature of medicine by challenging the intuitive assumption that medicine is primarily defined by its ability to cure disease. Broadbent [2, 3] notes that medicine across history has often lacked reliable cures, yet has persisted as a respected professional practice. He reasons that if curing were truly the core of medicine, traditions with limited curative success should have disappeared. The historical endurance of medicine, despite frequent curative failure, demands a different explanation.
Broadbent advances two major theses in this context: the Curative Thesis and the Inquiry Thesis. The Curative Thesis states that medicine’s defining aim is “the sustained and organized effort to heal the sick, or prevent them from getting sick in the first place” [2, p. 35]. Broadbent adopts a generous definition of “cure” to include not only complete eradication of disease but also interventions that alleviate symptoms, reduce suffering, or extend life [1]. This framing allows palliative and preventive measures to count as curative in a broad sense.
However, Broadbent ultimately rejects the Curative Thesis. He argues that the historical and cross-cultural record undermines its emphasis on cure and treatment as the defining feature of medicine: medicine has frequently failed to deliver cures, especially prior to the twentieth century [13, 14]. The analogy he offers is striking; professions such as blacksmithing or taxi-driving cannot survive long without producing functional tools or transporting passengers. By contrast, medicine has continued despite long stretches of poor curative success. Broadbent’s answer to this puzzle is that medicine persists because it provides something more fundamental than cures: the competencies of prediction and understanding.
Broadbent uses examples to illustrate these claims. Consider the case of a patient with a necrotic finger [2]. The physician predicts accurately that the finger will change colour and fall off, even though no cure is offered. This is still recognized as legitimate medical practice because the doctor demonstrates both understanding of the pathology and predictive competence regarding its progression.
Prediction, in Broadbent’s account, is not merely an optional skill but a logical precursor to cure. For an intervention to qualify as a genuine cure (rather than a fortunate accident – luck), recovery must be predicted on the basis of the treatment, and a worse outcome must be predicted without it. He gives the counterexample of a burglar who recovers from illness after randomly ingesting pharmacy drugs; this, for Broadbent, cannot count as a medical cure because it lacks both predictive basis and explanatory grounding [2].
Understanding is equally central. Historically, periods of major therapeutic breakthroughs have followed advances in medical understanding, particularly after the scientific revolution and into the twentieth century [15]. For Broadbent, this reinforces that prediction and understanding are primary competencies, while cure is secondary, emerging from their successful application.
In defending the Inquiry Thesis, Broadbent explicitly positions it as a cross-cultural account. He acknowledges that medical traditions vary widely but insists that prediction and understanding are the shared competencies that persist across time and place [2]. This move is intended to avoid privileging Western biomedicine. However, as later sections will show, his selection of competencies may itself be culturally loaded. While prediction and understanding are robustly present in Western medicine, their role in traditions such as ATM is more complex.
Broadbent’s account has not gone unchallenged. Critics such as Metz [6] and Harris [5] have questioned both the descriptive adequacy and conceptual coherence of the Inquiry Thesis. Metz points to medicine’s long history of false explanatory frameworks (e.g., humoral theory, miasma theory) to question whether ‘understanding’ should be considered a core competency when so much of it has been wrong. Harris, examining patient movement between ATM and biomedicine, observes that patients’ choices are often driven less by explanatory capacity than by pragmatic hope for a cure—casting doubt on whether understanding is primary in practice.
African traditional medicine (ATM) encompasses a diverse set of indigenous medical practices, belief systems, and knowledge traditions developed and transmitted across generations throughout the African continent [16–18]. Although ATM varies by region and culture, it is unified by its holistic approach to health, integrating physical, spiritual, and social dimensions of well-being. It is neither a peripheral nor declining tradition: in South Africa, for example, up to 80% of Black South Africans consult traditional healers at some point [10]. ATM is also institutionally recognized [11]. The South African Traditional Health Practitioners Act (Act No. 22 of 2007) formally regulates traditional healers, underscoring that ATM is part of the national health framework rather than merely an informal spiritual practice [12].
ATM conceptualizes health as the harmonious balance of bodily, spiritual, and social elements. Illness is often interpreted as the disruption of this equilibrium, sometimes through biological causes, but frequently through social disharmony, ancestral displeasure, or malevolent spiritual forces [16, 19]. This epistemological orientation contrasts sharply with the disease ontology of Western biomedicine, which largely localizes illness in physical pathology [20]. In ATM, restoring health typically involves simultaneous attention to the physical body, spiritual relations, and social environment.
Traditional healers, variously known in Southern Africa as sangomas, inyangas, diviners, or herbalists, are central to ATM’s operation. They serve not only as therapeutic practitioners but also as custodians of social and spiritual order. Their expertise is grounded in an apprenticeship process that typically begins with dreams or visions interpreted as a “calling” from ancestors, leading to initiation (ukuthwasa) [16, 21]. The healer’s diagnostic and therapeutic actions are thus epistemologically embedded in ancestral communication.
Spirituality is not an optional dimension of ATM practice but constitutive of its methodology. For example, in Southern Africa, the spirit of a deceased relative (idlozi) may be understood to inhabit the healer temporarily, offering guidance for diagnosis and treatment [22]. This model departs from the biomedical ideal of explanation grounded in mechanistic understanding, but it is nonetheless authoritative within the cultural epistemology of ATM.
An important domain of ATM is herbal medicine. Indigenous pharmacopeia, transmitted orally across generations, encompasses a wide range of plant-based remedies for ailments ranging from common colds to chronic illnesses [17, 21]. While some herbal formulations have been investigated scientifically, leading to recognition of their pharmacological properties, many remain understudied, partly due to epistemic biases in global health research [19]. The persistence of herbal remedies in ATM reflects both their perceived efficacy and the epistemic authority of the healer’s expertise in preparing, dosing, and contextualizing their use.
ATM operates within a fundamentally communal framework. Illness is often conceptualized as not solely affecting an individual but as embedded in the family or community network [17]. In some cases, such as those involving spiritual attacks, the condition is thought to implicate entire kinship groups, necessitating collective consultation and ritual participation [16, 23]. Healing rituals, such as community cleansing ceremonies, serve both therapeutic and social-cohesive functions, reaffirming community bonds while addressing perceived causes of illness.
One important question for philosophical analysis is whether ATM should be classified as a medical tradition or as a form of spiritual or religious practice. This is especially pressing in the context of Broadbent’s Inquiry Thesis, which is intended to cover ‘medicine’ across traditions. While ATM includes elements that might resemble religious ritual to external observers, it is institutionally and socially understood as a form of healthcare amongst the greater African people [18]. Of course, healthcare—and healing more broadly—is understood within ATM as an interconnected relationship between the biological, social, and spiritual. National health policies in multiple African states, including South Africa, Ghana, and Mali, officially incorporate ATM into their health systems [12, 18]. Patients seek out ATM not primarily for abstract spiritual benefits but for concrete interventions aimed at alleviating illness, restoring health, and preventing future disease [5]. This practical orientation justifies its consideration as a medical system within comparative philosophy of medicine.
The preceding section presented ATM as a socially recognized, institutionally regulated, and widely practiced medical tradition. The present section tests Broadbent’s Inquiry Thesis against ATM in detail. Broadbent identifies two core competencies as defining the nature of medicine: prediction and understanding. These competencies are intended to be universal across time, tradition, and place [2]. The key question, then, is whether they are reliably present in ATM in the form that Broadbent envisions.
In this section, I argue that these competencies are not consistently exercised in ATM as Broadbent defines them, and that the way competence is recognized in ATM diverges from his framework. This is not merely a descriptive difference; it has direct implications for the Inquiry Thesis, because Broadbent’s account requires these competencies to be reliably identifiable across all traditions in order to function as the unifying definition of medicine [2, 3].
Broadbent’s first major defence of the Inquiry Thesis rests on inference to the best explanation [2, 24]. His reasoning is straightforward: if a patient regards a practitioner as competent despite the absence of a cure, the best explanation is that the practitioner has demonstrated medical expertise through understanding and prediction. For example, Broadbent’s necrotic finger case involves a physician who predicts the progression of the condition (color change, eventual detachment) without offering a cure. The physician is nonetheless recognized as competent because they have demonstrated both understanding of the pathology and predictive skill.
The superior spiritual power of an adversary [16, 17].
Ancestral displeasure or unmet ritual obligations [21, 23].
The healer’s misalignment with certain spiritual forces or the need for a more powerful healer [19, 22, 23].
Broadbent’s second defence of the Inquiry Thesis stresses the logical primacy of prediction over cure. For a cure to count as a genuine expression of medical competence, recovery must be predicted with treatment and deterioration predicted without it. This, for Broadbent, is the key to avoiding the attribution of “cure” to luck [2]. In ATM, however, predictive claims are rarely expressed in the conditional form Broadbent envisions. In trance-healing and other diagnostic practices, healers typically do not frame outcomes in terms of explicit counterfactual reasoning: If you follow this intervention, recovery will occur; if you do not, the condition will worsen. Instead, predictions are often embedded in a spiritual narrative. A sangoma might say that an illness will improve if the patient performs certain rituals or makes offerings to appease the ancestors [22, 23].
While such statements have a predictive element, they are not structured as testable hypotheses in both the biomedical and Broadbent’s senses. They are conditional only within the logic of the spiritual framework: recovery is contingent on spiritual alignment, not on physiological causation as Western medicine understands it [16, 19].
Understanding presents an even sharper challenge to the Inquiry Thesis. Broadbent’s ‘understanding thesis’ requires that medicine engage meaningfully in attaining understanding of health and illness. Understanding is framed as explanatory, with conceptual grasp of causal mechanisms playing a central role [2]. In ATM, particularly in trance-healing, the healer’s role is not to demonstrate mechanistic comprehension but to act as a conduit for knowledge from spiritual agents. As Mncube [22] describes:
This is strikingly similar to Metz’s “oracle” thought experiment [6], in which an oracle can direct effective healing without possessing scientific understanding. If the oracle case counts as medicine without mechanistic understanding, Broadbent’s framework would need to stretch “understanding” to include ‘non-explanationist’ epistemologies [9]. But this would blur the very conceptual boundaries that give the Inquiry Thesis its normative force.
Why does it matter how patients explain competence? The Inquiry Thesis uses patient recognition of competence as part of its justification for prediction and understanding as universal features. Broadbent argues that even when cures fail, patients continue to trust practitioners who display these competencies [2].
Broadbent’s rejection of pluralism is based on the idea that pluralism risks collapsing into vagueness, leaving one without a clear, principled account of what unites different medical traditions. His concern mirrors debates in philosophy of science about “cluster concepts” such as  game, art, or health. These concepts accommodate diversity by listing overlapping characteristics rather than a single necessary and sufficient condition [25].
In the case of medicine, a pluralist might argue that there is no single universal competency (prediction, understanding, cure, or otherwise) that appears in every medical tradition. Instead, there is a family resemblance among different practices: some traditions emphasize herbal pharmacology, some rely on spiritual diagnosis, others stress empirical observation, but all occupy a shared cultural category of “medicine” due to overlapping aims, roles, and methods [6]. While this approach avoids forcing a single competency across diverse traditions, it risks becoming analytically inert. If any culturally recognized healing practice can count as medicine without a clear criterion, then the term ‘medicine’ loses the explanatory precision Broadbent is seeking. The pluralist position might succeed descriptively but fail normatively, leaving one without a principled way to distinguish legitimate medicine from, for example, pseudo-medicine or purely religious rituals.
Descriptively: ATM is recognized as part of the health sector in multiple African countries. In South Africa, the Traditional Health Practitioners Act establishes legal categories for different types of healers (herbalists, diviners, traditional birth attendants) and regulates their practice [12]. The World Health Organization similarly includes traditional medicine in its strategic framework for health systems strengthening [26]. These institutional recognitions are not mere cultural niceties; they have material effects on healthcare policy, resource allocation, and patient care.
Normatively: Denying ATM’s status as medicine risks a parochialism that Broadbent himself seeks to avoid. If a definition of medicine excludes traditions that millions of people recognize as their primary source of healthcare, then that definition is both descriptively inaccurate and ethically problematic [27]. It would marginalize large populations and undermine cross-cultural dialogue about healthcare policy.
This refined version differs from the ‘naïve’ Curative Thesis in several key respects. First, it does not require consistent success at curing disease. Instead, it recognizes that medicine can legitimately persist even when cures are rare or partial, so long as the aim remains directed toward health improvement [8]. Second, it accommodates practices where cure is conceptualized differently, as in ATM, where healing may involve restoring harmony between physical, spiritual, and social dimensions rather than eradicating a pathogen [16, 21]. Third, it allows for multiple epistemic routes to curative aims. Whereas the Inquiry Thesis limits legitimacy to systems with prediction and understanding as Broadbent defines them, RCT recognizes that these competencies are valuable instruments but not universal criteria.

Sections

"[{\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR1\", \"CR3\", \"CR4\", \"CR9\"], \"section\": \"Introduction\", \"text\": \"Alex Broadbent has recently reignited philosophical debate by asking, somewhat provocatively, why so little attention has been paid to the foundational question of what medicine is [1\\u20133]. While much has been written about medical ethics, epistemology, and methodology, Broadbent contends that the very nature of medicine itself has been comparatively neglected. I largely agree with this observation. His claims have sparked significant discussion [4\\u20139], drawing attention to questions about medicine\\u2019s aims, its epistemic capacities, and its nature.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR1\", \"CR2\", \"CR2\"], \"section\": \"Introduction\", \"text\": \"Broadbent positions himself against the traditional and what might fairly appear intuitive, the \\u201cCurative Thesis,\\u201d which holds that the ability to cure is an\\u00a0essential defining feature\\u00a0 of\\u00a0the nature of\\u00a0medicine. Instead, he advances the \\u201cInquiry Thesis,\\u201d according to which medicine\\u2019s defining features are its competencies of prediction and understanding [1, 2]. This move is meant to make the definition less parochial, avoiding a model that privileges only Western biomedicine by identifying competencies that could, in principle and practice, be shared across medical traditions [2].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR10\", \"CR11\", \"CR12\"], \"section\": \"Introduction\", \"text\": \"This paper examines this tension through a sustained case study of ATM. The choice of ATM is not incidental: it remains a major medical system for millions of people in sub-Saharan Africa. Particularly in Southern Africa, surveys suggest that up to 80% of the Black South African population consults traditional healers [10, 11]. ATM is not merely a set of spiritual or cultural practices; it is recognized under national health regulations in South Africa and elsewhere as a legitimate part of the health sector [12]. For this reason, ATM offers a valuable test case for evaluating whether Broadbent\\u2019s account can truly encompass global medical diversity.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\", \"CR3\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Broadbent\\u2019s recent work has revitalized discussion on the fundamental question of the nature of medicine by challenging the intuitive assumption that medicine is primarily defined by its ability to cure disease. Broadbent [2, 3] notes that medicine across history has often lacked reliable cures, yet has persisted as a respected professional practice. He reasons that if curing were truly the core of medicine, traditions with limited curative success should have disappeared. The historical endurance of medicine, despite frequent curative failure, demands a different explanation.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR1\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Broadbent advances two major theses in this context: the Curative Thesis and the Inquiry Thesis. The Curative Thesis states that medicine\\u2019s defining aim is \\u201cthe sustained and organized effort to heal the sick, or prevent them from getting sick in the first place\\u201d [2, p. 35]. Broadbent adopts a generous definition of \\u201ccure\\u201d to include not only complete eradication of disease but also interventions that alleviate symptoms, reduce suffering, or extend life [1]. This framing allows palliative and preventive measures to count as curative in a broad sense.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR13\", \"CR14\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"However, Broadbent ultimately rejects the Curative Thesis. He argues that the historical and cross-cultural record undermines its emphasis on cure and treatment as the defining feature of medicine: medicine has frequently failed to deliver cures, especially prior to the twentieth century [13, 14]. The analogy he offers is striking; professions such as blacksmithing or taxi-driving cannot survive long without producing functional tools or transporting passengers. By contrast, medicine has continued despite long stretches of poor curative success. Broadbent\\u2019s answer to this puzzle is that medicine persists because it provides something more fundamental than cures: the competencies of prediction and understanding.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Broadbent uses examples to illustrate these claims. Consider the case of a patient with a necrotic finger [2]. The physician predicts accurately that the finger will change colour and fall off, even though no cure is offered. This is still recognized as legitimate medical practice because the doctor demonstrates both understanding of the pathology and predictive competence regarding its progression.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Prediction, in Broadbent\\u2019s account, is not merely an optional skill but a logical precursor to cure. For an intervention to qualify as a genuine cure (rather than a fortunate accident \\u2013 luck), recovery must be predicted on the basis of the treatment, and a worse outcome must be predicted without it. He gives the counterexample of a burglar who recovers from illness after randomly ingesting pharmacy drugs; this, for Broadbent, cannot count as a medical cure because it lacks both predictive basis and explanatory grounding [2].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR15\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Understanding is equally central. Historically, periods of major therapeutic breakthroughs have followed advances in medical understanding, particularly after the scientific revolution and into the twentieth century [15]. For Broadbent, this reinforces that prediction and understanding are primary competencies, while cure is secondary, emerging from their successful application.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"In defending the Inquiry Thesis, Broadbent explicitly positions it as a cross-cultural account. He acknowledges that medical traditions vary widely but insists that prediction and understanding are the shared competencies that persist across time and place [2]. This move is intended to avoid privileging Western biomedicine. However, as later sections will show, his selection of competencies may itself be culturally loaded. While prediction and understanding are robustly present in Western medicine, their role in traditions such as ATM is more complex.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR6\", \"CR5\"], \"section\": \"Broadbent on the nature of medicine\", \"text\": \"Broadbent\\u2019s account has not gone unchallenged. Critics such as Metz [6] and Harris [5] have questioned both the descriptive adequacy and conceptual coherence of the Inquiry Thesis. Metz points to medicine\\u2019s long history of false explanatory frameworks (e.g., humoral theory, miasma theory) to question whether \\u2018understanding\\u2019 should be considered a core competency when so much of it has been wrong. Harris, examining patient movement between ATM and biomedicine, observes that patients\\u2019 choices are often driven less by explanatory capacity than by pragmatic hope for a cure\\u2014casting doubt on whether understanding is primary in practice.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR16\", \"CR18\", \"CR10\", \"CR11\", \"CR12\"], \"section\": \"African traditional medicine\", \"text\": \"African traditional medicine (ATM) encompasses a diverse set of indigenous medical practices, belief systems, and knowledge traditions developed and transmitted across generations throughout the African continent [16\\u201318]. Although ATM varies by region and culture, it is unified by its holistic approach to health, integrating physical, spiritual, and social dimensions of well-being. It is neither a peripheral nor declining tradition: in South Africa, for example, up to 80% of Black South Africans consult traditional healers at some point [10]. ATM is also institutionally recognized [11]. The South African Traditional Health Practitioners Act (Act No. 22 of 2007) formally regulates traditional healers, underscoring that ATM is part of the national health framework rather than merely an informal spiritual practice [12].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR16\", \"CR19\", \"CR20\"], \"section\": \"Holistic conception of health\", \"text\": \"ATM conceptualizes health as the harmonious balance of bodily, spiritual, and social elements. Illness is often interpreted as the disruption of this equilibrium, sometimes through biological causes, but frequently through social disharmony, ancestral displeasure, or malevolent spiritual forces [16, 19]. This epistemological orientation contrasts sharply with the disease ontology of Western biomedicine, which largely localizes illness in physical pathology [20]. In ATM, restoring health typically involves simultaneous attention to the physical body, spiritual relations, and social environment.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR16\", \"CR21\"], \"section\": \"Role of healers and\\u00a0spirituality\", \"text\": \"Traditional healers, variously known in Southern Africa as sangomas, inyangas, diviners, or herbalists, are central to ATM\\u2019s operation. They serve not only as therapeutic practitioners but also as custodians of social and spiritual order. Their expertise is grounded in an apprenticeship process that typically begins with dreams or visions interpreted as a \\u201ccalling\\u201d from ancestors, leading to initiation (ukuthwasa) [16, 21]. The healer\\u2019s diagnostic and therapeutic actions are thus epistemologically embedded in ancestral communication.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR22\"], \"section\": \"Role of healers and\\u00a0spirituality\", \"text\": \"Spirituality is not an optional dimension of ATM practice but constitutive of its methodology. For example, in Southern Africa, the spirit of a deceased relative (idlozi) may be understood to inhabit the healer temporarily, offering guidance for diagnosis and treatment [22]. This model departs from the biomedical ideal of explanation grounded in mechanistic understanding, but it is nonetheless authoritative within the cultural epistemology of ATM.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR17\", \"CR21\", \"CR19\"], \"section\": \"Herbal medicine and indigenous knowledge\", \"text\": \"An important domain of ATM is herbal medicine. Indigenous pharmacopeia, transmitted orally across generations, encompasses a wide range of plant-based remedies for ailments ranging from common colds to chronic illnesses [17, 21]. While some herbal formulations have been investigated scientifically, leading to recognition of their pharmacological properties, many remain understudied, partly due to epistemic biases in global health research [19]. The persistence of herbal remedies in ATM reflects both their perceived efficacy and the epistemic authority of the healer\\u2019s expertise in preparing, dosing, and contextualizing their use.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR17\", \"CR16\", \"CR23\"], \"section\": \"Social and communal dimensions of healing\", \"text\": \"ATM operates within a fundamentally communal framework. Illness is often conceptualized as not solely affecting an individual but as embedded in the family or community network [17]. In some cases, such as those involving spiritual attacks, the condition is thought to implicate entire kinship groups, necessitating collective consultation and ritual participation [16, 23]. Healing rituals, such as community cleansing ceremonies, serve both therapeutic and social-cohesive functions, reaffirming community bonds while addressing perceived causes of illness.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR18\", \"CR12\", \"CR18\", \"CR5\"], \"section\": \"ATM as a medical tradition\", \"text\": \"One important question for philosophical analysis is whether ATM should be classified as a medical tradition or as a form of spiritual or religious practice. This is especially pressing in the context of Broadbent\\u2019s Inquiry Thesis, which is intended to cover \\u2018medicine\\u2019 across traditions. While ATM includes elements that might resemble religious ritual to external observers, it is institutionally and socially understood as a form of healthcare amongst the greater African people [18]. Of course, healthcare\\u2014and healing more broadly\\u2014is understood within ATM as an interconnected relationship between the biological, social, and spiritual. National health policies in multiple African states, including South Africa, Ghana, and Mali, officially incorporate ATM into their health systems [12, 18]. Patients seek out ATM not primarily for abstract spiritual benefits but for concrete interventions aimed at alleviating illness, restoring health, and preventing future disease [5]. This practical orientation justifies its consideration as a medical system within comparative philosophy of medicine.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\"], \"section\": \"Inquiry thesis and African traditional medicine\", \"text\": \"The preceding section presented ATM as a socially recognized, institutionally regulated, and widely practiced medical tradition. The present section tests Broadbent\\u2019s Inquiry Thesis against ATM in detail. Broadbent identifies two core competencies as defining the nature of medicine: prediction and understanding. These competencies are intended to be universal across time, tradition, and place [2]. The key question, then, is whether they are reliably present in ATM in the form that Broadbent envisions.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\", \"CR3\"], \"section\": \"Inquiry thesis and African traditional medicine\", \"text\": \"In this section, I argue that these competencies are not consistently exercised in ATM as Broadbent defines them, and that the way competence is recognized in ATM diverges from his framework. This is not merely a descriptive difference; it has direct implications for the Inquiry Thesis, because Broadbent\\u2019s account requires these competencies to be reliably identifiable across all traditions in order to function as the unifying definition of medicine [2, 3].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\", \"CR24\"], \"section\": \"Broadbent\\u2019s argument from inference to the best explanation\", \"text\": \"Broadbent\\u2019s first major defence of the Inquiry Thesis rests on inference to the best explanation [2, 24]. His reasoning is straightforward: if a patient regards a practitioner as competent despite the absence of a cure, the best explanation is that the practitioner has demonstrated medical expertise through understanding and prediction. For example, Broadbent\\u2019s necrotic finger case involves a physician who predicts the progression of the condition (color change, eventual detachment) without offering a cure. The physician is nonetheless recognized as competent because they have demonstrated both understanding of the pathology and predictive skill.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR16\", \"CR17\"], \"section\": \"\", \"text\": \"The superior spiritual power of an adversary [16, 17].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR21\", \"CR23\"], \"section\": \"\", \"text\": \"Ancestral displeasure or unmet ritual obligations [21, 23].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR19\", \"CR22\", \"CR23\"], \"section\": \"\", \"text\": \"The healer\\u2019s misalignment with certain spiritual forces or the need for a more powerful healer [19, 22, 23].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\", \"CR22\", \"CR23\"], \"section\": \"Prediction in ATM: conditionality, reliability, and context\", \"text\": \"Broadbent\\u2019s second defence of the Inquiry Thesis stresses the logical primacy of prediction over cure. For a cure to count as a genuine expression of medical competence, recovery must be predicted with treatment and deterioration predicted without it. This, for Broadbent, is the key to avoiding the attribution of \\u201ccure\\u201d to luck [2]. In ATM, however, predictive claims are rarely expressed in the conditional form Broadbent envisions. In trance-healing and other diagnostic practices, healers typically do not frame outcomes in terms of explicit counterfactual reasoning: If you follow this intervention, recovery will occur; if you do not, the condition will worsen. Instead, predictions are often embedded in a spiritual narrative. A sangoma might say that an illness will improve if the patient performs certain rituals or makes offerings to appease the ancestors [22, 23].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR16\", \"CR19\"], \"section\": \"Prediction in ATM: conditionality, reliability, and context\", \"text\": \"While such statements have a predictive element, they are not structured as testable hypotheses in both the biomedical and Broadbent\\u2019s senses. They are conditional only within the logic of the spiritual framework: recovery is contingent on spiritual alignment, not on physiological causation as Western medicine understands it [16, 19].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\", \"CR22\"], \"section\": \"Understanding in ATM: the trance-healing challenge\", \"text\": \"Understanding presents an even sharper challenge to the Inquiry Thesis. Broadbent\\u2019s \\u2018understanding thesis\\u2019 requires that medicine engage meaningfully in attaining understanding of health and illness. Understanding is framed as explanatory, with conceptual grasp of causal mechanisms playing a central role [2]. In ATM, particularly in trance-healing, the healer\\u2019s role is not to demonstrate mechanistic comprehension but to act as a conduit for knowledge from spiritual agents. As Mncube [22] describes:\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR6\", \"CR9\"], \"section\": \"Understanding in ATM: the trance-healing challenge\", \"text\": \"This is strikingly similar to Metz\\u2019s \\u201coracle\\u201d thought experiment [6], in which an oracle can direct effective healing without possessing scientific understanding. If the oracle case counts as medicine without mechanistic understanding, Broadbent\\u2019s framework would need to stretch \\u201cunderstanding\\u201d to include \\u2018non-explanationist\\u2019 epistemologies [9]. But this would blur the very conceptual boundaries that give the Inquiry Thesis its normative force.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR2\"], \"section\": \"Patient explanations and the recognition of competence\", \"text\": \"Why does it matter how patients explain competence? The Inquiry Thesis uses patient recognition of competence as part of its justification for prediction and understanding as universal features. Broadbent argues that even when cures fail, patients continue to trust practitioners who display these competencies [2].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR25\"], \"section\": \"The pluralism question: can one abandon a single defining core?\", \"text\": \"Broadbent\\u2019s rejection of pluralism is based on the idea that pluralism risks collapsing into vagueness, leaving one without a clear, principled account of what unites different medical traditions. His concern mirrors debates in philosophy of science about \\u201ccluster concepts\\u201d such as \\u00a0game, art, or health. These concepts accommodate diversity by listing overlapping characteristics rather than a single necessary and sufficient condition [25].\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR6\"], \"section\": \"The pluralism question: can one abandon a single defining core?\", \"text\": \"In the case of medicine, a pluralist might argue that there is no single universal competency (prediction, understanding, cure, or otherwise) that appears in every medical tradition. Instead, there is a family resemblance among different practices: some traditions emphasize herbal pharmacology, some rely on spiritual diagnosis, others stress empirical observation, but all occupy a shared cultural category of \\u201cmedicine\\u201d due to overlapping aims, roles, and methods [6]. While this approach avoids forcing a single competency across diverse traditions, it risks becoming analytically inert. If any culturally recognized healing practice can count as medicine without a clear criterion, then the term \\u2018medicine\\u2019 loses the explanatory precision Broadbent is seeking. The pluralist position might succeed descriptively but fail normatively, leaving one without a principled way to distinguish legitimate medicine from, for example, pseudo-medicine or purely religious rituals.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR12\", \"CR26\"], \"section\": \"\", \"text\": \"Descriptively: ATM is recognized as part of the health sector in multiple African countries. In South Africa, the Traditional Health Practitioners Act establishes legal categories for different types of healers (herbalists, diviners, traditional birth attendants) and regulates their practice [12]. The World Health Organization similarly includes traditional medicine in its strategic framework for health systems strengthening [26]. These institutional recognitions are not mere cultural niceties; they have material effects on healthcare policy, resource allocation, and patient care.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR27\"], \"section\": \"\", \"text\": \"Normatively: Denying ATM\\u2019s status as medicine risks a parochialism that Broadbent himself seeks to avoid. If a definition of medicine excludes traditions that millions of people recognize as their primary source of healthcare, then that definition is both descriptively inaccurate and ethically problematic [27]. It would marginalize large populations and undermine cross-cultural dialogue about healthcare policy.\"}, {\"pmc\": \"PMC12583263\", \"pmid\": \"41037080\", \"reference_ids\": [\"CR8\", \"CR16\", \"CR21\"], \"section\": \"Towards a refined curative thesis\", \"text\": \"This refined version differs from the \\u2018na\\u00efve\\u2019 Curative Thesis in several key respects. First, it does not require consistent success at curing disease. Instead, it recognizes that medicine can legitimately persist even when cures are rare or partial, so long as the aim remains directed toward health improvement [8]. Second, it accommodates practices where cure is conceptualized differently, as in ATM, where healing may involve restoring harmony between physical, spiritual, and social dimensions rather than eradicating a pathogen [16, 21]. Third, it allows for multiple epistemic routes to curative aims. Whereas the Inquiry Thesis limits legitimacy to systems with prediction and understanding as Broadbent defines them, RCT recognizes that these competencies are valuable instruments but not universal criteria.\"}]"

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