While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do not (...) subscribe to feminist science studies’ normative program——where contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework. -/- See response by Sharyn Clough: http://wp.me/p1Bfg0-1aN See reply by Maya Goldenberg: http://wp.me/p1Bfg0-1oY. (shrink)

The purpose of this thesis is to provide a robust epistemological justification for Evidence Based Medicine (EMB), and thereby to demonstrate the epistemological short comings of Complementary and Alternative Medicine (CAM). CAM has received support from both philosophers, such as Rorty and Feyerband, and the Sociology and Anthropology of Medicine. The thesis will thus review both the internal coherence and the application of non-realist arguments, and counter non-realism with the realist epistemology and philosophy of science that is represented by C.S. (...) Peirce’s pragmatism. Rorty and Feyerabend and others have developed radical forms of scientific antirealism in the latter 20th century. Subsequently, sociologists developed even more intractable forms of anti-realism, which they applied to the social study of science. This approach served to challenge the legitimacy of orthodox scientific practice (including EMB). A practical expression of this controversy was immediately identified in the question of the role of scientific authority in a democratic society. That question was immediately applied to the status of alternative medical systems and their legitimacy vis-a-vis EBM in terms of the controversy over what has come to be termed "medical pluralism": If scientific medicine has no particular authority, should other, medical systems, epistemically incompatible with EBM, be made available as well? The thesis will suggest that non-realism is in fact a marginal position within the philosophy of science. Scientists, medical researchers and medical practitioners may thus appeal to the philosophy of science in order to justify their authority in the face of challenges from CAM. However, it will be suggested that they are frequently ill-served by a reliance on a simplistic understanding of the philosophy of Karl Popper. An alternative will be proposed in the philosophy of C. S. Peirce. His pragmatism offers to medical research and medical practice a way of understanding and justifying the scientific process, a justification of realism in the face of non-realism, and a resource for the criticism of CAM and medical pluralism, as at once epistemologically ill grounded and potentially dangerous to patients and the general public. (shrink)

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between (...) EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM. (shrink)