Rationale, Aims, and Objectives: Confidence (or belief) that a therapy is effective is essential to practicing clinical medicine. GRADE, a popular framework for developing clinical recommendations, provides a means for assigning how much confidence one should have in a therapy's effect estimate. One's level of confidence (or “degree of belief”) can also be modelled using Bayes theorem. In this paper, we look through both a GRADE and Bayesian lens to examine how one determines confidence in the effect estimate. Methods: Philosophical (...) examination. Results: The GRADE framework uses a criteria‐based method to assign a quality of evidence level. The criteria pertain mostly to considerations of methodological rigour, derived from a modified evidence‐based medicine evidence hierarchy. The four levels of quality relate to the level of confidence one should have in the effect estimate. The Bayesian framework is not bound by a predetermined set of criteria. Bayes theorem shows how a rational agent adjusts confidence (ie, degree of belief) in the effect estimate on the basis of the available evidence. Such adjustments relate to the principles of incremental confirmation and evidence proportionism. Use of the Bayesian framework reveals some potential pitfalls in GRADE's criteria‐based thinking on confidence that are out of step with our intuitions on evidence. Conclusions: A rational thinker uses all available evidence to formulate beliefs. The GRADE criteria seem to suggest that we discard some of that information when other, more favoured information (eg, derived from clinical trials) is available. The GRADE framework should strive to ensure that the whole evidence base is considered when determining confidence in the effect estimate. The incremental value of such evidence on determining confidence in the effect estimate should be assigned in a manner that is theoretically or empirically justified, such that confidence is proportional to the evidence, both for and against it. (shrink)

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a (...) medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing “biological plausibility” of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. (shrink)

The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a (...) number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the “grades of evidence” provided by GRADE, while explicit, are functionally vague. Second, the “criteria for assigning grade of evidence” is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient preferences, and trade‐offs between costs, benefits, and harms when proposing a clinical practice recommendation. Much of the GRADE method requires judgement on the part of the user, making it unclear as to how the framework reduces bias in recommendations or makes them more transparent—both goals of the programme. It is our view that the issues presented in this paper undermine GRADE's justificatory scheme, thereby limiting the usefulness of GRADE as a tool for developing clinical recommendations. (shrink)

Rationale, aims, and objectives: One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARSCoV- 2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper is the first part of a series of two papers that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific knowledge (...) during the COVID-19 pandemic. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers, and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimising biases and increasing objectivity, were, instead, the subject of fruitless oppositions. The duplication of research works, combined with poor-quality research, has greatly contributed to slowing down the creation of novel scientific knowledge. Conclusions: The COVID-19 pandemic presented challenges in terms of (1) finding and prioritising relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. (shrink)

Rationale, aims and objectives: The COVID-19 pandemic has impacted every facet of society, including medical research. This paper is the second part of a series of articles that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of novel scientific knowledge during the COVID-19 pandemic. In the first part of this series, we demonstrated that, in the context of COVID-19, the scientific community has been faced with numerous challenges with respect to (1) finding (...) and prioritizing relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peerreviewed journals, pre-print servers and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This second paper demonstrates that a lack of research prioritization and methodological rigour resulted in the generation of fleeting and inconsistent evidence that complicated the development of public health guidelines. The reporting of scientific findings to the scientific community and general public highlighted the difficulty of finding a balance between accuracy and speed. Conclusions: The COVID-19 pandemic presented challenges in terms of (3) evaluating evidence for the purpose of making evidence-based decisions and (4) sharing scientific findings with the rest of the scientific community. This second paper demonstrates that the four challenges outlined in the first and second papers have often compounded each other and have contributed to slowing down the creation of novel scientific knowledge during the COVID-19 pandemic. (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...) of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

List of Illustrations Introduction 1 The Didactic and the Elegant: Some Thoughts on Scientific and Technological Illustrations in the Middle Ages and Renaissance 3 2 Temples of the Body and Temples of the Cosmos: Vision and Visualization in the Vesalian and Copernican Revolutions 40 3 Descartes’s Scientific Illustrations and ’la grande mecanique de la nature’ 86 4 Illustrating Chemistry 135 5 Representations of the Natural System in the Nineteenth Century 164 6 Visual Representation in Archaeology: Depicting the Missing-Link in Human (...) Origins 184 7 Towards an Epistemology of Scientific Illustration 215 8 Illustration and Inference 250 9 Visual Models and Scientific Judgment 269 10 Are Pictures Really Necessary? The Case of Sewall Wright’s ’Adaptive Landscapes’ 303 Bibliography 339 Notes on Contributors 373 Index 377. (shrink)

This chapter contains section titled: Kepler's New Astronomy Kepler's New Science of Vision Galileo and the Telescope Galileo and the Creation of Mathematical Physics Mersenne and the New Science.

The new inter-disciplinary eclecticism championed by many philosophers of science has generated a heterogeneous family of science studies projects. Philosophers who favor an inter-disciplinary approach face many problems if they are to successfully forge a hybrid science studies that does not violate their integrity as philosophers in particular, they must isolate an intellectual space in which traditional agendas, such as the concern for the clarification of concepts, can hold court. In this paper, I outline what I regard as a new (...) brand of HPS, one that is deeply rooted in the history of the exact science. The virtue of this New HPS, I will submit, is that it furnishes philosophers of science with a fresh perspective from which to carry on philosophy's classic normative mission. (shrink)

Brief response to Brian Baigrie's "The Justification of Kepler’s Ellipse" (1990).

We provide a new interpretation of Zeno’s Paradox of Measure that begins by giving a substantive account, drawn from Aristotle’s text, of the fact that points lack magnitude. The main elements of this account are (1) the Axiom of Archimedes which states that there are no infinitesimal magnitudes, and (2) the principle that all assignments of magnitude, or lack thereof, must be grounded in the magnitude of line segments, the primary objects to which the notion of linear magnitude applies. Armed (...) with this account, we are ineluctably driven to introduce a highly constructive notion of (outer) measure based exclusively on the total magnitude of potentially infinite collections of line segments. The Paradox of Measure then consists in the proof that every finite or potentially infinite collection of points lacks magnitude with respect to this notion of measure. We observe that the Paradox of Measure, thus understood, troubled analysts into the 1880’s, despite their knowledge that the linear continuum is uncountable. The Paradox was ultimately resolved by Borel in his thesis of 1893, as a corollary to his celebrated result that every countable open cover of a closed line segment has a finite sub-cover, a result he later called the “First Fundamental Theorem of Measure Theory.” This achievement of Borel has not been sufficiently appreciated. We conclude with a metamathematical analysis of the resolution of the paradox made possible by recent results in reverse mathematics. (shrink)

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. Epstein (...) explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

In his insightful and challenging paper, Jonathan Schaffer argues against a distinction I make in The Ant Trap (Epstein 2015) and related articles. I argue that in addition to the widely discussed “grounding” relation, there is a different kind of metaphysical determination I name “anchoring.” Grounding and anchoring are distinct, and both need to be a part of full explanations of how facts are metaphysically determined. Schaffer argues instead that anchoring is a species of grounding. The crux of his argument (...) comes in the last sections of his paper, in his discussion of “exportation,” the relations strategy, and the definitions strategy. I am inclined to agree that Schaffer’s interesting strategies offer the best choices for the philosopher who wants to insist that anchoring is a species of grounding. But both, I will argue, are fatally flawed. I do not take the separation of anchors from grounds lightly, but find the evidence in its favor overwhelming. And once the distinction is made, I find anchoring to be a powerful practical tool in metaphysics. Philosophy and Phenomenological Research, Volume 99, Issue 3, Page 768-781, November 2019. (shrink)

Intuitively, Gettier cases are instances of justified true beliefs that are not cases of knowledge. Should we therefore conclude that knowledge is not justified true belief? Only if we have reason to trust intuition here. But intuitions are unreliable in a wide range of cases. And it can be argued that the Gettier intuitions have a greater resemblance to unreliable intuitions than to reliable intuitions. Whats distinctive about the faulty intuitions, I argue, is that respecting them would mean abandoning a (...) simple, systematic and largely successful theory in favour of a complicated, disjunctive and idiosyncratic theory. So maybe respecting the Gettier intuitions was the wrong reaction, we should instead have been explaining why we are all so easily misled by these kinds of cases. (shrink)

Dogmatism is sometimes thought to be incompatible with Bayesian models of rational learning. I show that the best model for updating imprecise credences is compatible with dogmatism.

Conciliatory theories of disagreement face a revenge problem; they cannot be coherently believed by one who thinks they have peers who are not conciliationists. I argue that this is a deep problem for conciliationism.

Many writers have held that in his later work, David Lewis adopted a theory of predicate meaning such that the meaning of a predicate is the most natural property that is (mostly) consistent with the way the predicate is used. That orthodox interpretation is shared by both supporters and critics of Lewis's theory of meaning, but it has recently been strongly criticised by Wolfgang Schwarz. In this paper, I accept many of Schwarze's criticisms of the orthodox interpretation, and add some (...) more. But I also argue that the orthodox interpretation has a grain of truth in it, and seeing that helps us appreciate the strength of Lewis's late theory of meaning. (shrink)

ABSTRACTRational agents have consistent beliefs. Bayesianism is a theory of consistency for partial belief states. Rational agents also respond appropriately to experience. Dogmatism is a theory of how to respond appropriately to experience. Hence, Dogmatism and Bayesianism are theories of two very different aspects of rationality. It's surprising, then, that in recent years it has become common to claim that Dogmatism and Bayesianism are jointly inconsistent: how can two independently consistent theories with distinct subject matter be jointly inconsistent? In this (...) essay I argue that Bayesianism and Dogmatism are inconsistent only with the addition of a specific hypothesis about how the appropriate responses to perceptual experience are to be incorporated into the formal models of the Bayesian. That hypothesis isn't essential either to Bayesianism or to Dogmatism, and so Bayesianism and Dogmatism are jointly consistent. That leaves the matter of how experiences and credences are related, a... (shrink)

Suppose a rational agent S has some evidence E that bears on p, and on that basis makes a judgment about p. For simplicity, we’ll normally assume that she judges that p, though we’re also interested in cases where the agent makes other judgments, such as that p is probable, or that p is well-supported by the evidence. We’ll also assume, again for simplicity, that the agent knows that E is the basis for her judgment. Finally, we’ll assume that the (...) judgment is a rational one to make, though we won’t assume the agent knows this. Indeed, whether the agent can always know that she’s making a rational judgment when in fact she is will be of central importance in some of the debates that follow. (shrink)

Timothy Williamson has recently argued that few mental states are luminous , meaning that to be in that state is to be in a position to know that you are in the state. His argument rests on the plausible principle that beliefs only count as knowledge if they are safely true. That is, any belief that could easily have been false is not a piece of knowledge. I argue that the form of the safety rule Williamson uses is inappropriate, and (...) the correct safety rule might not conflict with luminosity. (shrink)

What question are decision theorists trying to answer, and why is it worth trying to answer it? A lot of philosophers talk as if the aim of decision theory is to describe how we should make decisions, and the reason to do this is to help us make better decisions. I disagree on both fronts. The aim of the decision theory is to describe how a certain kind of idealised decider does in fact decide. And the reason to do this (...) is that this idealisation, like many other idealisations, helps generate explanations of real-world behaviour. We shouldn't do what these ideal deciders do, or try to be more like them, because a lot of what they do only makes sense because of the differences between us and them. Still, sometimes those differences are small enough that they can be ignored in explanations, and that's when decision theory is useful. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

Vagueness as Indeterminacy. I defend the traditional view that a vague term is one with an indeterminate denotation from a bevy of recent challenges.

What the world needs now is another theory of vagueness. Not because the old theories are useless. Quite the contrary, the old theories provide many of the materials we need to construct the truest theory of vagueness ever seen. The theory shall be similar in motivation to supervaluationism, but more akin to many-valued theories in conceptualisation. What I take from the many-valued theories is the idea that some sentences can be truer than others. But I say very different things to (...) the ordering over sentences this relation generates. I say it is not a linear ordering, so it cannot be represented by the real numbers. I also argue that since there is higher-order vagueness, any mapping between sentences and mathematical objects is bound to be inappropriate. This is no cause for regret; we can say all we want to say by using the comparative truer than without mapping it onto some mathematical objects. From supervaluationism I take the idea that we can keep classical logic without keeping the familiar bivalent semantics for classical logic. But my preservation of classical logic is more comprehensive than is normally permitted by supervaluationism, for I preserve classical inference rules as well as classical sequents. And I do this without relying on the concept of acceptable precisifications as an unexplained explainer. The world does not need another guide to varieties of theories of vagueness, especially since Timothy Williamson (1994) and Rosanna Keefe (2000) have already provided quite good guides. I assume throughout familiarity with popular theories of vagueness. (shrink)

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

This paper contributes to the project of articulating and defending the supra-Bayesian approach to judgment aggregation. I discuss three cases where a person is disposed to defer to two different experts, and ask how they should respond when they learn about the opinion of each. The guiding principles are that this learning should go by conditionalisation, and that they should aim to update on the evidence that the expert had updated on. But this doesn’t settle how the update on pairs (...) of experts should go, because we also need to know how the experts are related. I work through three examples showing how the results change given different prior beliefs about this relationship. (shrink)

Uncertainty plays an important role in The General Theory, particularly in the theory of interest rates. Keynes did not provide a theory of uncertainty, but he did make some enlightening remarks about the direction he thought such a theory should take. I argue that some modern innovations in the theory of probability allow us to build a theory which captures these Keynesian insights. If this is the right theory, however, uncertainty cannot carry its weight in Keynes’s arguments. This does not (...) mean that the conclusions of these arguments are necessarily mistaken; in their best formulation they may succeed with merely an appeal to risk. (shrink)

In 1688 the Irish scientist and politician William Molyneux sent a letter to the philosopher John Locke. In it, he asked him a question: could someone who was born blind, and able to distinguish a globe and a cube by touch, be able to immediately distinguish and name these shapes by sight if given the ability to see? -/- The philosophical puzzle offered in Molyneux’s letter fascinated not only Locke, but major thinkers such as Leibniz, Berkeley, Diderot, Reid, and numerous (...) others including psychologists and cognitive scientists today. Does such a question represent a philosophical puzzle or a problem that can be solved by experimental tests? Can vision be fully restored after blindness? What is the relation between vision and touch? Are the senses linked through learning or bound at birth? -/- Molyneux’s Question and the History of Philosophy is a major collection of essays that explore the long-standing issues Molyneux’s problem presents to philosophy of mind, perception and the senses. In addition, the volume considers the question from an interdisciplinary angle, examines the pre-history of the question, and aspects of it that have been ignored, such as perspectives from religion and disability. -/- As such, Molyneux’s Question and the History of Philosophy presents a set of philosophically rich, empirically informed, and scientifically rigorous original investigations into this famous puzzle. It will be of great interest to students and researchers in philosophy, psychology, and the cognitive sciences including neuroscience, neurobiology and ophthalmology, as well as those studying the mind, perception and the senses. (shrink)

In this paper, we show that presentism -- the view that the way things are is the way things presently are -- is not undermined by the objection from being-supervenience. This objection claims, roughly, that presentism has trouble accounting for the truth-value of past-tense claims. Our demonstration amounts to the articulation and defence of a novel version of presentism. This is brute past presentism, according to which the truth-value of past-tense claims is determined by the past understood as a fundamental (...) aspect of reality different from things and how things are. (shrink)