While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in a (...) pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)

How does science work? Does it tell us what the world is "really" like? What makes it different from other ways of understanding the universe? In Theory and Reality , Peter Godfrey-Smith addresses these questions by taking the reader on a grand tour of one hundred years of debate about science. The result is a completely accessible introduction to the main themes of the philosophy of science. Intended for undergraduates and general readers with no prior background in philosophy, Theory and (...) Reality covers logical positivism the problems of induction and confirmation Karl Popper's theory of science Thomas Kuhn and "scientific revolutions" the views of Imre Lakatos, Larry Laudan, and Paul Feyerabend and challenges to the field from sociology of science, feminism, and science studies. The book then looks in more detail at some specific problems and theories, including scientific realism, the theory-ladeness of observation, scientific explanation, and Bayesianism. Finally, Godfrey-Smith defends a form of philosophical naturalism as the best way to solve the main problems in the field. Throughout the text he points out connections between philosophical debates and wider discussions about science in recent decades, such as the infamous "science wars." Examples and asides engage the beginning student a glossary of terms explains key concepts and suggestions for further reading are included at the end of each chapter. However, this is a textbook that doesn't feel like a textbook because it captures the historical drama of changes in how science has been conceived over the last one hundred years. Like no other text in this field, Theory and Reality combines a survey of recent history of the philosophy of science with current key debates in language that any beginning scholar or critical reader can follow. (shrink)