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Show Review: [Untitled] Reviewed Work(s): A Novel Defense of Scientific Realism by Jarrett Leplin Stephen Downes Isis, Vol. 90, No. 1. (Mar., 1999), pp. 161-162. Stable URL: http://links.jstor.org/sici?sici=0021-1753%28199903%2990%3A1%3C161%3AANDOSR%3E2.0.CO%3B2-9 Isis is currently published by The University of Chicago Press. Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/about/terms.html. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/journals/ucpress.html. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. The JSTOR Archive is a trusted digital repository providing for long-term preservation and access to leading academic journals and scholarly literature from around the world. The Archive is supported by libraries, scholarly societies, publishers, and foundations. It is an initiative of JSTOR, a not-for-profit organization with a mission to help the scholarly community take advantage of advances in technology. For more information regarding JSTOR, please contact support@jstor.org. http://www.jstor.org Mon Oct 15 19:24:32 2007 BOOK REVIEWS-ISIS, 90: 1 (1999) 161 but they do not detract significantly from a generally clear and straightforward presentation. McDermott does not identify or analyze the forces driving the extraordinary growth of academic medical groups like the surgeons at New England Deaconess. He instead offers a unique perspective on the sequence of changes that moved this one group forward. The book closes with a two-paragraph postscript referring to the sudden and unexpected intrusions of insurance companies onto the scene. It seems to be intended as a message in a bottle left behind at the end of a prosperous era. CHRISTOPHER CRENNER Robert Cunningham III; Robert M. Cunningham, Jr. The Blues: A History of the Blue Cross and Blue Shield System. DeKalb: Northern Illinois University Press, 1997. An institutional history that is not only impressively researched but also readable, this book succeeds in a genre where success does not come easily. The Blues: A History of the Blue Cross and Blue Shield System examines the evolution of the two oldest and largest health insurance organizations in America. Starting with the first Blue Cross plan in Dallas nearly seven decades ago, the Cunninghams assiduously document the controversial prepayment movement, ending with its present-day incarnations (health maintenance organizations [HMOs] and related "managed care" structures). Moreover, The Blues will remind medical historians how profoundly Blue Cross and Blue Shield-a uniquely American patchwork of locally developed nonprofit organizations that later grew to cover the vast majority of Americans for hospital and medical care-have influenced the development of health policy in the United States. The authors begin with a comprehensive history of the political and economic forces that fostered the prepaid health care movement during the 1920s and 1930s, a movement that produced not only Blue Cross but also the Shadid cooperative in Oklahoma and the Ross-Loos clinic in Los Angeles. They spotlight both troubled and model Blue Cross plans, explain the impassioned opposition to the idea by the American Medical Association, and elucidate the continued boom in demand for Blue Cross coverage through the 1960s. In the late 1960s public trust in the Plans, along with their struggle for national coordination, cast them in the role of intermediary between the new Medicare and Medicaid programs and hospitals, physicians, and subscribers. Pe-rennial pressure to adulterate the original Blue Cross approach (inclusive service, rather than limited indemnity, benefits; broad, communitybased underwriting of risks) constitutes one of several subtle themes in this book. Compromise, of course, ultimately prevailed. Denied their traditional tax-exempt status in 1986 and confronted with intensifying competition for business, the Blues finally merged into a single association and, to stay in business, deliberately "reinvented" themselves to accommodate the HMO juggernaut of the 1980s and 1990s. In part because the Blue Cross and Blue Shield Association, which sponsored the research, made its voluminous national and local sources available to the authors, the Cunninghams were well placed to bring out the complexities and nuances of pluralistic American policy making and its peculiar hodgepodge of interest groups. Further, both authors had considerable experience as health care researchers, writers, and editors. (The elder Cunningham, who died before the book came out, had also been a consultant to the association.) The Blues is peppered with photographs (mainly portraits of organization leaders) and features an extensive glossary, helpful for dealing with the multitude of abbreviations that invariably crop up in discussions of health policy. Although the bibliography includes almost all the key works on the rise of health insurance and prepayment, readers must remember that the Blues, and not general health policy, are the focus of the work. One regrettable defect is the absence of graphic illustrations to show trends in enrollment, the spread of the Plans across the country, and changes in the relative sizes of commercial and nonprofit insurance markets over time. The Cunninghams also fail to speak to the impact, if any, that the Blues may have had on actual health status. Absent, too, are the voices of subscribers themselves. Nevertheless, The Blues will likely become a classic for its inquiry into the ancestry of managed care. And its audience will certainly extend beyond science policy historians; political economists and organizational behavior theorists, among others, will also no doubt find The Blues to be an overdue and welcome addition to their shelves. ROBERT B. SULLIVAN • Sociology & Philosophy of Science Jarrett Leplin. A Novel Defense of Scientific Realism. xii + 204 pp., fig., bibl., index. New 162 BOOK REVIEWS-ISIS, 90 : 1 (1999) York/Oxford: Oxford University Press, 1997. $39.95. Many historians of science may hope that p~losophers will one day stop arguing about scientific realism and come and join in the hard business of achieving a historically informed understanding of science. But Jarrett Leplin's book guarantees that there will be more arguing about scientific realism among philosophers of science, if only because Leplin claims to have the only defensible argument for scientific realism and in presenting it dismisses many of his peers' efforts at refuting realism. Nobody believes uniqueness claims and nobody likes to be dismissed. Thus the debate will continue. Leplin bases his defense of realism on the concept of novelty. A scientific claim is novel, on his view, if it is unique to a particular theory and independent from that theory's development. Uniqueness and independence are best understood in terms of Leplin's examples. AugustinJean Fresnel's bright spot is unique in that its relevance can be assessed only from the perspective of Fresnel's wave theory. The bright spot is independent in that it was not a component of the foundations of the theory. These definitions need more attention, but let us first look at how Leplin's assumptions relate to scientific realism. Simply put, if a theory presents novel results, correctly construed, that theory accesses the truth about the world. Leplin's exposition of this view is sustained and detailed. Chapter 1 is a long argument defending the role of truth in explanation and therefore in the explanation of scientific success. In Chapter 2 Leplin reviews previous conceptions of novelty in philosophy of science, paying most attention to Irnre Lakatos's treatment ofthe subject. This chapter concludes with a first pass at Leplin's own account of novelty. In Chapter 3 Leplin presents and argues for his new conception of novelty; in the following chapter, he applies it to some cases in the history of science. Chapter 5 connects novelty and realism: here Leplin defends a minimal epistemic realism (epistemic realism is the view that we can find truths about the world, not the view that there are truths about the world). In Chapter 6 Leplin deals with counterarguments to realism, particularly those presented by Arthur Fine and Bas Van Fraassen. And in the final chapter he argues that contemporary physics might need to adopt new methods if it is to succeed in its goals of establishing a grand unified theory. Leplin's approach is that of unabashed rational reconstruction. "Independence" and "uniqueness" are defined logically, and the logical relations between a result and a theory are so important that a "result is logically an ingredient in the foundations of [a] theory, even if it is psychologically and historically absent from them" (p. 91). Throughout much of the book, in fact, Leplin proceeds as if history and sociology of science had still not been discovered as avenues through which to gain understanding of science. Sociology of science is something Leplin has "gotten over"; thus, he maintains, worries about it can be dismissed. And although he claims to embrace history of science (pp. 5-6), his reconstructions of events in the history of science rely more on points of logic than on historical fact. Many readers will not get past Leplin's first chapter, in which he harmners home the point that the truth of a theory is in and of itself explanatory of its success, feeling that they have heard this claim too many times before. This response would be unfair, as Leplin's later arguments contain a great deal of subtlety and detail. But for the most part, the intended audience for these arguments is philosophers of science, well versed in the realism debates. Contemporary physicists, whom Leplin addresses in the final chapter, will doubtless be uninterested in a philosopher telling them that their methods will come to naught, and historians will find no new interpretations of the history of physics. How philosophers of science respond to the book depends on how much life there is left in the realism/ antirealism debate. Arthur Fine, whom Leplin criticizes, took it upon himself to use that debate to attempt to steer philosophers of science away from such disputes toward developing a more nuanced understanding of the concepts and practice of science. Fine was pushing more of an attitude about the study of science than a thesis about realism: Perhaps we philosophers of science should work on our attitude a little more. STEPHEN DOWNES • Reference Tools Jean-Fran~ois Stoffel (Editor). Pierre Duhem et ses doctorands: Bibliographie de la litterature primaire et secondaire. Introduction by Stanley L. Jald. (Reminisciences, 1.) 326 pp., bibl., indexes. Louvain-Ia-Neuve, France: Centre Interfacultaire d'Etude en Histoire des Sciences, 1996. Fr 1,200 (paper). Pierre Duhem was one of the founders of the modem historical study of medieval physics, |
