A revised translation of Heidegger's most important work.

This classic remains one of Karl Popper's most wide-ranging and popular works, notable not only for its acute insight into the way scientific knowledge grows, but also for applying those insights to politics and to history.

The way in which knowledge progresses, and especially our scientific knowledge, is by unjustified anticipations, by guesses, by tentative solutions to our problems, by conjectures. These conjectures are controlled by criticism: that is, by attempted refutations, which include severely critical tests. They may survive these tests; but they can never be positively justified: they can neither be established as certainly true nor even as 'probable'. Criticism of our conjectures is of decisive importance: by bringing out our mistakes it makes us (...) understand the difficulties of the problems which we try to solve. This is how we become better acquainted with our problem, and able to propose more mature solutions: the very refutation of a theory - that is, of a tentative solution to our problem - is always a step forward that takes us nearer the truth. And this is how we can learn from our mistakes. As we learn from our mistakes our knowledge grows, even though we may never know - that is, know for certain. Since our knowledge can grow, there can be no reason here for despair of reason. And since we can never know for certain, the can be no authority here for any claim to authority, for conceit over our knowledge, or for smugness. The essays and lectures of which this book is composed apply this thesis to many topics, ranging from problems of the philosophy and history of the physical and social sciences to historical and political problems. (shrink)

Best known as a philosopher, one of the founders of existentialism, Kierkegaard also wrote books whose themes were primarily religious, psychological or literary. He was opposed to much in organised Christianity, stressing the necessity for individual choice against prescribed dogma and ritual. In this book, he concentrates his penetrating psychological observations on the theme of despair.

There is a section in Samuel Delany’s magnificent autobiographical meditation, The Motion of Light in Water, that dramatically raises the problem of writing the history of difference, the history, that is, of the designation of “other,” of the attribution of characteristics that distinguish categories of people from some presumed norm.1 Delany recounts his reaction to his first visit to the St. Marks bathhouse in 1963. He remembers standing on the threshold of a “gym-sized room” dimly lit by blue bulbs. The (...) room was full of people, some standing, the rest an undulating mass of naked, male bodies, spread wall to wall. My first response was a kind of heart-thudding astonishment very close to fear. I have written of a space at certain libidinal saturation before. That was not what frightened me. It was rather that the saturation was not only kinesthetic but visible.2Watching the scene establishes for Delany a “fact that flew in the face” of the prevailing representation of homosexuals in the 1950s as “isolated perverts,” as subjects “gone awry.” The “apprehension of massed bodies” gave him a “sense of political power”:what this experience said was that there was a population—not of individual homosexuals … not of hundreds, not of thousands, but rather of millions of gay men, and that history had, actively and already, created for us whole galleries of institutions, good and bad, to accommodate our sex. [M, p. 174] 2. Samuel R. Delany, The Motion of Light in Water: Sex and Science Fiction Writing in the East Village, 1957-1965 , p. 173; hereafter abbreviated M. Joan W. Scott is professor of social science at the Institute for Advanced Study in Princeton, New Jersey. She is the author, most recently, of Gender and the Politics of History and is currently at work on a history of feminist claims for political rights in France during the period 1789-1945 as a way of exploring arguments about equality and difference. (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)

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five (...) distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

The Concept of Time presents the reconstructed text of a lecture delivered by Martin Heidegger to the Marburg Theological Society in 1924. It offers a fascinating insight into the developmental years leading up to the publication, in 1927, of his magnum opus Being and Time, itself one of the most influential philosophical works this century. In The Concept of Time Heidegger introduces many of the central themes of his analyses of human existence which were subsequently incorporated into Being and Time, (...) themes such as Dasein, Being-in-the-world, everydayness, disposition, care, authenticity, death, uncanniness, temporality and historicity. Starting out by asking: What is time?, Heidegger proceeds to radicalise the concept of time and our relation to it, ending with the question: Are we ourselves time? Am I time? (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)

Contesting that a debate on evidence-based health care has taken place, this article charts three paths to the future: continuing avoidance of debate by proponents of evidence-based medicine (EBM); conflict, which the EBM movement courts and critics have espoused, and dialogue. The last portal allows for integration, which would end the disagreement between EBM and its critics and make a debate unnecessary. In search of integration, I sketch a bridge whose construction requires not compromise but a win- win approach. The (...) bridge is a medicine of meaning (MOM). Consolidating multiple pillars of evidence to unify questions that are not necessarily the same for protagonists and critics of EBM, a MOM contends that the purpose or meaning of medicine is always healing and helping, and each party finds meaning in medicine by contributing to this common purpose in its own distinctive way. (shrink)

Edited by two leading general practitioners and with contributions from over 20 authors, this book covers a wide range of topics to do with narrative in medicine. It includes a wealth of real examples of patients narratives and addresses theoretical and practical issues including the use of narrative as a therapeutic tool, teaching narrative to students, philosophical issues, narrative in legal and ethical decisions, narrative in nursing, and the narrative medical record.

The proposed practice of "evidence-based medicine," which calls for careful clinical judgment in evaluating the "best available evidence," should be differentiated from the special collection of data regarded as suitable evidence. Although the proposed practice does not seem new, the new collection of "best available" information has major constraints for the care of individual patients. Derived almost exclusively from randomized trials and meta-analyses, the data do not include many types of treatments or patients seen in clinical practice; and the results (...) show comparative efficacy of treatment for an "average" randomized patient, not for pertinent subgroups formed by such cogent clinical features as severity of symptoms, illness, co-morbidity, and other clinical nuances. The intention-to-treat analyses do not reflect important post-randomization events leading to altered treatment; and the results seldom provide suitable background data when therapy is given prophylactically rather than remedially, or when therapeutic advantages are equivocal. Randomized trial information is also seldom available for issues in etiology, diagnosis, and prognosis, and for clinical decisions that depend on pathophysiologic changes, psychosocial factors and support, personal preferences of patients, and strategies for giving comfort and reassurance. The laudable goal of making clinical decisions based on evidence can be impaired by the restricted quality and scope of what is collected as "best available evidence." The authoritative aura given to the collection, however, may lead to major abuses that produce inappropriate guidelines or doctrinaire dogmas for clinical practice. (shrink)