Experimental philosophers advocate expansion of philosophical methods to include empirical investigation into the concepts used by ordinary people in reasoning and action. We propose also including methods of qualitative social science, which we argue serve both moral and epistemic goals. Philosophical analytical tools applied to interdisciplinary research designs can provide ways to extract rich contextual information from subjects. We argue that this approach has important implications for bioethics; it provides both epistemic and moral reasons to use the experiences and perspectives (...) of diverse populations to better identify underlying concepts as well as to develop effective interventions within particular communities. (shrink)

Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical literature. It (...) finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)

Francesco Guala once wrote that ‘The problem of extrapolation is a minor scandal in the philosophy of science’. This paper agrees with the statement, but for reasons different from Guala’s. The scandal is not, or not any longer, that the problem has been ignored in the philosophy of science. The scandal is that framing the problem as one of external validity encourages poor evidential reasoning. The aim of this paper is to propose an alternative—an alternative which constitutes much better evidential (...) reasoning about target systems of interest, and which makes do without consideration of external validity. (shrink)

Semmelweis’s work predates the discovery of the power of randomization in medicine by almost a century. Although Semmelweis would not have consciously used a randomized controlled trial (RCT), some features of his material—the allocation of patients to the first and second clinics—did involve what was in fact a randomization, though this was not realised at the time. This article begins by explaining why Semmelweis’s methodology, nevertheless, did not amount to the use of a RCT. It then shows why it is (...) descriptively and normatively interesting to compare what he did with the modern approach using RCTs. The argumentation centres on causal inferences and the contrast between Semmelweis’s causal concept and that deployed by many advocates of RCTs. It is argued that Semmelweis’s approach has implications for matters of explanation and medical practice. (shrink)