Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

Educationalists introduce students to literature search strategies that, with rare exceptions, focus chiefly on the location of primary research reports and systematic reviews of those reports. These sources are, however, unlikely to adequately address the normative and/or metaphysical questions that nurses frequently and legitimately interest themselves in. To meet these interests, non‐research texts exploring normative and/or metaphysical topics might and perhaps should, in some situations, be deemed suitable search targets. This seems plausible and, moreover, students are encouraged to ‘read widely’. (...) Yet accepting this proposition creates significant difficulties. Specifically, if non‐research scholarly sources and artistic or literary (humanities) products dealing with normative/metaphysical issues were included in what are, at present, scientifically orientated searches, it is difficult to draw boundaries around what – if anything – is to be excluded. Engaging with this issue highlights problems with qualitative scholarship's designation as ‘evidence’. Thus, absurdly, if qualitative scholarship's findings are labelled evidence because they generate practice‐relevant understanding/insight, then any literary or artistic artefact (e.g. a throwaway lifestyle magazine) that generates kindred understandings/insights is presumably also evidence? This conclusion is rejected and it is instead proposed that while artistic, literary, and qualitative inquiries can provide practitioners with powerful and stimulating non‐evidential understanding, these sources are not evidence as commonly conceived. (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)