The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, (...) and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. (shrink)

A probabilistic explication is offered of equipoise and uncertainty in clinical trials. In order to be useful in the justification of clinical trials, equipoise has to be interpreted in terms of overlapping probability distributions of possible treatment outcomes, rather than point estimates representing expectation values. Uncertainty about treatment outcomes is shown to be a necessary but insufficient condition for the ethical defensibility of clinical trials. Additional requirements are proposed for the nature of that uncertainty. The indecisiveness of our criteria for (...) cautious decision-making under uncertainty creates the leeway that makes clinical trials defensible. (shrink)

One of the motivations for Salmon's (1984) causal theory of explanation was the explanatory irrelevance exhibited by many arguments conforming to Hempel's covering-law models of explanation. However, the nexus of causal processes and interactions characterized by Salmon is not rich enough to supply the necessary conception of explanatory relevance. Salmon's (1994) revised theory, which is briefly criticized on independent grounds, fares no better. There is some possibility that the two-tiered structure of explanation described by Salmon (1984) may be pressed into (...) service, but more work would have to be done. Ironically, Salmon's difficulties are similar to those suffered by his seventeenth-century predecessors. (shrink)

1. Introduction. The papers by Hellman and Mayo offer up a rich menu of problems and proposed solutions, so there is much here for a friendly critic to fasten on. In order to bring a modicum of focus to my commentary, I shall limit my remarks to the Duhem problem and its radiations in epistemology and methodology. Both Mayo and Hellman claim to have solutions to that hoary old problem and they tout these solutions as key indicators of the explanatory (...) power of their respective technical epistemologies, whether Bayesian or Neyman/Pearsonian. Like Mayo, I shall be arguing that the Bayesian treatment of Duhem's problem is no solution at all; that, indeed, it fails to grapple with the core challenges posed by the purported ambiguities of falsification. My response to Mayo's more detailed, and I think more right-headed, treatment of the Duhem problem will be more complex. While I believe that she is moving in the right direction in many respects, I think that she fails to see one key dimension of the Duhemian conundrum. Indeed, she risks solving not Duhem's problem but quite a different one. I shall gently try to encourage her to steer her way back towards the central task. (shrink)

"Applied" is a technical term describing a variety of new philosophical enterprises. The author examines and rejects the view that these fields are derivative. Whatever principles, judgments, or background theories that are employed to solve problems in these areas are either changed by how they are used, or at least the possibility exists of their being changed. Hence we ought to stop calling these endeavors "applied", or agree that the meaning of "apply" will have to include the possibility that what (...) is applied may be changed. The socalled applied fields of philosophy, therefore, are not derivative. The strongest cases to the contrary are the foundationalist views that what we apply is epistemically privileged. Different foundationalist views take different principles, judgments, or background theories to be epistemically privileged. Strong and weak versions of each of these foundationalist views are considered but none establish these fields as derivative. Keywords: applied ethics, background theories, casuistry, epistemic privilige, foundationalism, principles, reflective equilibrium CiteULike Connotea Del.icio.us What's this? (shrink)