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: 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)

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)

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)

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)

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.

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)

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

Value pluralists believe in multiple dimensions of value. What does betterness along a dimension have to do with being better overall? Any systematic answer begins with the Strong Pareto principle: one thing is overall better than another if it is better along one dimension and at least as good along all others. We defend Strong Pareto from recent counterexamples and use our discussion to develop a novel view of dimensions of value, one which puts Strong Pareto on firmer footing. We (...) conclude by defending Dimensionalism, the hypothesis that overall value relations are determined solely by how things compare along value dimensions. These are first steps towards a more systematic value pluralism. (shrink)

I advocate Time-Slice Rationality, the thesis that the relationship between two time-slices of the same person is not importantly different, for purposes of rational evaluation, from the relationship between time-slices of distinct persons. The locus of rationality, so to speak, is the time-slice rather than the temporally extended agent. This claim is motivated by consideration of puzzle cases for personal identity over time and by a very moderate form of internalism about rationality. Time-Slice Rationality conflicts with two proposed principles of (...) rationality, Conditionalization and Reflection. Conditionalization is a diachronic norm saying how your current degrees of belief should fit with your old ones, while Reflection is a norm enjoining you to defer to the degrees of belief that you expect to have in the future. But they are independently problematic and should be replaced by improved, time-slice-centric principles. Conditionalization should be replaced by a synchronic norm saying what degrees of belief you ought to have given your current evidence and Reflection should be replaced by a norm which instructs you to defer to the degrees of belief of agents you take to be experts. These replacement principles do all the work that the old principles were supposed to do while avoiding their problems. In this way, Time-Slice Rationality puts the theory of rationality on firmer foundations and yields better norms than alternative, non-time-slice-centric approaches. (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)

Virtues are acquirable, so if intellectual humility is a virtue, it’s acquirable. But there is something deeply problematic—perhaps even paradoxical—about aiming to be intellectually humble. Drawing on Edward Slingerland’s analysis of the paradoxical virtue of wu-wei in Trying Not To Try (New York: Crown, 2014), we argue for an anti-individualistic conception of the trait, concluding that one’s intellectual humility depends upon the intellectual humility of others. Slingerland defines wu-wei as the “dynamic, effortless, and unselfconscious state of mind of a person (...) who is optimally active and effective” (Trying Not to Try, 7). Someone who embodies wu-wei inspires implicit trust, so it is beneficial to appear wu-wei. This has led to an arms race between faking wu-wei on the one hand and detecting fakery on the other. Likewise, there are many benefits to being (or seeming to be) intellectually humble. But someone who makes conscious, strategic efforts to appear intellectually humble is ipso facto not intellectually humble. Following Slingerland’s lead, we argue that there are several strategies one might pursue to acquire genuine intellectual humility, and all of these involve commitment to shared social or epistemic values, combined with receptivity to feedback from others, who must in turn have and manifest relevant intellectual virtues. In other words, other people and shared values are partial bearers of a given individual’s intellectual humility. If this is on the right track, then acquiring intellectual humility demands epistemic anti-individualism. (shrink)

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We (...) also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

Brian C. Ribeiro’s _Sextus, Montaigne, Hume: Pyrrhonizers_ invites us to view the Pyrrhonist tradition as involving all those who share a commitment to the activity of Pyrrhonizing and develops fresh, provocative readings of Sextus, Montaigne, and Hume as radical Pyrrhonizing skeptics.

Our universe features a harmonious match between laws and states: applying its laws to its states generates other states. This is a striking fact. Matters might have been otherwise. The universe might have been stillborn in a state unengaged by its laws. The problem of nomological harmony is that of explaining the noted striking fact. After introducing and developing this problem, we canvass candidate solutions and identify some of their virtues and vices. Candidate solutions invoke the likes of a designer, (...) axiarchic meta-laws, multiverses, essential causal powers, and Humean laws. (shrink)

This paper develops a new argument from consciousness to theism: the argument from psychophysical harmony. Roughly, psychophysical harmony consists in the fact that phenomenal states are correlated with physical states and with one another in strikingly fortunate ways. For example, phenomenal states are correlated with behavior and functioning that is justified or rationalized by those very phenomenal states, and phenomenal states are correlated with verbal reports and judgments that are made true by those very phenomenal states. We argue that psychophysical (...) harmony is strong evidence for theism (or, at least, strong evidence against atheism in its standard naturalistic form). (shrink)

ABSTRACT Quine insisted that the satisfaction of an open modalised formula by an object depends on how that object is described. Kripke's ‘objectual’ interpretation of quantified modal logic, whereby variables are rigid, is commonly thought to avoid these Quinean worries. Yet there remain residual Quinean worries for epistemic modality. Theorists have recently been toying with assignment-shifting treatments of epistemic contexts. On such views an epistemic operator ends up binding all the variables in its scope. One might worry that this yields (...) the undesirable result that any attempt to ‘quantify in’ to an epistemic environment is blocked. If quantifying into the relevant constructions is vacuous, then such views would seem hopelessly misguided and empirically inadequate. But a famous alternative to Kripke's semantics, namely Lewis' counterpart semantics, also faces this worry since it also treats the boxes and diamonds as assignment-shifting devices. As I'll demonstrate, the mere fact that a variable is bound is no obstacle to binding it. This provides a helpful lesson for those modelling de re epistemic contexts with assignment sensitivity, and perhaps leads the way toward the proper treatment of binding in both metaphysical and epistemic contexts: Kripke for metaphysical modality, Lewis for epistemic modality. (shrink)

We present an account of the phenomenon of music based upon the hypothesis that there is a close parallel between the mechanics of life and the mechanics of mind, a key factor in the correspondence proposed being the existence of close parallels between the concepts of gene and musical idea. The hypothesis accounts for the specificity, complexity, functionality and apparent arbitrariness of musical structures. An implication of the model is that music should be seen as a phenomenon of transcendental character, (...) involving aspects of mind as yet unstudied by conventional science. (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)

A common framing has it that any adequate treatment of quotation has to abandon one of the following three principles: (i) The quoted expression is a syntactic constituent of the quote phrase; (ii) If two expressions are derived by applying the same syntactic rule to a sequence of synonymous expressions, then they are synonymous; (iii) The language contains synonymous but distinct expressions. In the following, a formal syntax and semantics will be provided for a quotational language which adheres to all (...) three principles. The point here is not merely to provide a “possibility proof”, but to reveal the hard constraints on the theory of quotation, and to highlight certain assumptions at the syntax/semantics/post-semantics interfaces. (shrink)

Certain puzzling cases have been discussed in the literature recently which appear to support the thought that knowledge can be obtained by way of deduction from a falsehood; moreover, these cases put pressure, prima facie, on the thesis of counter closure for knowledge. We argue that the cases do not involve knowledge from falsehood; despite appearances, the false beliefs in the cases in question are causally, and therefore epistemologically, incidental, and knowledge is achieved despite falsehood. We also show that the (...) principle of counter closure, and the concomitant denial of knowledge from falsehood, is well motivated by considerations in epistemological theory--in particular, by the view that knowledge is first in the epistemological order of things. (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)

This chapter defines "epistemology," introduces the key epistemological questions, and briefly outlines how the field has evolved over time. It serves as the introduction to the edited collection, Introduction to Philosophy: Epistemology (a volume in the Introduction to Philosophy open textbook series edited by Christina Hendricks).

I defend normative externalism from the objection that it cannot account for the wrongfulness of moral recklessness. The defence is fairly simple—there is no wrong of moral recklessness. There is an intuitive argument by analogy that there should be a wrong of moral recklessness, and the bulk of the paper consists of a response to this analogy. A central part of my response is that if people were motivated to avoid moral recklessness, they would have to have an unpleasant sort (...) of motivation, what Michael Smith calls “moral fetishism”. (shrink)

I consider the problem of how to derive what an agent believes from their credence function and utility function. I argue the best solution of this problem is pragmatic, i.e. it is sensitive to the kinds of choices actually facing the agent. I further argue that this explains why our notion of justified belief appears to be pragmatic, as is argued e.g. by Fantl and McGrath. The notion of epistemic justification is not really a pragmatic notion, but it is being (...) applied to a pragmatically defined concept, i.e. belief. (shrink)

A common view among nontheists combines the de jure objection that theism is epistemically unacceptable with agnosticism about the de facto objection that theism is false. Following Plantinga, we can call this a “proper” de jure objection—a de jure objection that does not depend on any de facto objection. In his Warranted Christian Belief, Plantinga has produced a general argument against all proper de jure objections. Here I first show that this argument is logically fallacious (it makes subtle probabilistic fallacies (...) disguised by scope ambiguities), and proceed to lay the groundwork for the construction of actual proper de jure objections. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

In large, impersonal moral orders many of us wish to maintain good will toward our fellow citizens only if we are reasonably sure they will maintain good will toward us. The mutual maintaining of good will, then, requires that we somehow communicate our intentions to one another. But how do we actually do this? The current paper argues that when we engage in moral responsibility practices—that is, when we express our reactive attitudes by blaming, praising, and resenting—we communicate a desire (...) to maintain good will to those in the community we are imbedded in. Participating in such practices alone will not get the job done, though, for expressions of our reactive attitudes are often what economists call cheap talk. But when we praise and blame in cases of moral diversity, expressions of our reactive attitudes act as costly signals capable of solving our social dilemma. (shrink)