"First Published in 1992, Routledge is an imprint of Taylor & Francis, an informa company.".

The phrase “statements of fact” has a clear, unequivocal ring. It speaks of a stable place untouchable by contests in epistemology and in more secular places, around questions of constructivism, subjectivism, and the politics of knowledge. It offers fixity, a locus of constancy in a shifting landscape where traditional certainties have ceased to hold, maintains a vantage point outside the fray, where knowledge-seekers can continue to believe in some degree of “correspondence” between items of knowledge and events in the world. (...) Within the social institutions and practices where knowledge is an issue, it designates a secure starting place for deliberation, a way of ensuring that processes of decision-making remain cognizant of the “realities” they have to address.In the institutions of knowledge production and knowledgeable practice that generate the examples I appeal to in this essay – medicine and law – “statements of fact” appear to comprise an incontestable core around which interpretive strategies may indeed have to be enlisted, but which itself functions as a kind of interpretation-exempt zone. There are good reasons for its retaining that status, for resisting the instabilities and sheer whimsicalities that would follow from dislodging it. (shrink)

Edmund Gettier is Professor Emeritus at the University of Massachusetts, Amherst. This short piece, published in 1963, seemed to many decisively to refute an otherwise attractive analysis of knowledge. It stimulated a renewed effort, still ongoing, to clarify exactly what knowledge comprises.

This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

Clinicians and policy makers the world over are embracing evidence-based medicine. The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational and objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to fair and effective healthcare (...) for all. In this paper I closely examine these claims from the perspective of healthcare for women, using relevant examples. I argue that the current processes of evidence-based medicine contain a number of biases against women. These biases occur in the production of the research that informs evidence-based medicine, in the methods used to analyse and synthesise the evidence, and in the application of EBM through the use of guidelines. Finally, the biomedical model of health that underpins most of the medical research used by EBM ignores the social and political context which contributes so much to the ill-health of women. (shrink)

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of (...) clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine. (shrink)

Evidentialism is a view about the conditions under which a person is epistemically justified in having a particular doxastic attitude toward a proposition. Evidentialism holds that the justified attitudes are determined entirely by the person's evidence. This is the traditional view of justification. It is now widely opposed. The essays included in this volume develop and defend the tradition.Evidentialism has many assets. In addition to providing an intuitively plausible account of epistemic justification, it helps to resolve the problem of the (...) criterion, helps to disentangle epistemic and ethical evaluations, and illuminates the relationship between epistemic evaluations of beliefs and the evaluation of the methods used to form beliefs. These issues are all addressed in the essays presented here. External world skepticism poses the classic problem for an epistemological theory. The final essay in this volume argues that evidentialism is uniquely well qualified to make sense of skepticism and to respond to its challenge.Evidentialism is a version of epistemic internalism. Recent epistemology has included many attacks on internalism and has seen the development of numerous externalist theories. The essays included here respond to those attacks and raise objections to externalist theories, especially the principal rival, reliabilism. Internalism generally has been criticized for having unacceptable deontological implications, for failing to connect epistemic justification to truth, and for failing to provide an adequate account of what makes basic beliefs justified. Each of these charges is answered in these essays. The collection includes two previously unpublished essays and new afterwords to five of the reprinted essays; it will be the definitive resource on evidentialism for all epistemologists. (shrink)

A wide-ranging study of the central concepts in epistemology - belief, truth and knowledge. Professor Armstrong offers a dispositional account of general beliefs and of knowledge of general propositions. Belief about particular matters of fact are described as structures in the mind of the believer which represent or 'map' reality, while general beliefs are dispositions to extend the 'map' or introduce casual relations between portions of the map according to general rules. 'Knowledge' denotes the reliability of such beliefs as representations (...) of reality. Within this framework Professor Armstrong offers a distinctive account of many of the main questions in general epistemology - the relations between beliefs and language, the notions of proposition, concept and idea, the analysis of truth, the varieties of knowledge, and the way in which beleifs and knowledge are supported by reasons. The book as a whole if offered as a contribution to a naturalistic account of man. (shrink)

The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920–1950). At the same time, the term ‘‘evidence-based medicine’’ has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should (...) be challenged on the grounds of how ‘evidence’ has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause. (shrink)