Cure as medicine's constitutive aim: a defence of the refined curative thesis.

Abstract

Medicine has persisted for thousands of years despite frequent therapeutic failures. What explains its persistence despite its failure to cure? I contend that the Inquiry thesis's view - seeing medicine's "core business" as prediction and understanding - rests on an unhelpful conceptual distinction between main goal and core business, along with an implausible "No Bullshit" premise. Instead, I support the refined Curative Thesis (RCT): medicine is united by a teleological (constitutive) aim to help the sick through socially organised and accountable interventions, even when cures are uncertain. Using conceptual analysis and analogies from comedy, mining, and policing, I demonstrate that professions can survive repeated failures in their main goals, revealing a symmetry: prediction and explanation often fail as well. This work is innovative in three ways: it discards "core business" as a defining tool, introduces a teleological boundary that accommodates epistemic diversity, and redefines prediction and understanding as instrumental goods intrinsic to medicine. It also relates RCT to other recent curative-focused and related accounts, such as Smart (Synthese 201(6):194, 2023); Varga (Science, medicine, and the aims of inquiry, Cambridge University Press, Cambridge, 2024); Stegenga (Care and cure, University of Chicago Press, Chicago, 2018), clarifying their significance.