Medical nihilism is the view that we should have little confidence in the effectiveness of medical interventions. Jacob Stegenga argues persuasively that this is how we should see modern medicine, and suggests that medical research must be modified, clinical practice should be less aggressive, and regulatory standards should be enhanced.

This paper explores how data serve as evidence for phenomena. In contrast to standard philosophical models which invite us to think of evidential relationships as logical relationships, I argue that evidential relationships in the context of data-to-phenomena reasoning are empirical relationships that depend on holding the right sort of pattern of counterfactual dependence between the data and the conclusions investigators reach on the phenomena themselves.

Evidence based medicine has been a topic of considerable controversy in medical and health care circles over its short lifetime, because of the claims made by its exponents about the criteria used to assess the evidence for or against the effectiveness of medical interventions. The central epistemological debates underpinning the debates about evidence based medicine are reviewed by this paper, and some areas are suggested where further work remains to be done. In particular, further work is needed on the theory (...) of evidence and inference; causation and correlation; clinical judgment and collective knowledge; the structure of medical theory; and the nature of clinical effectiveness. (shrink)

Objections to reliabilist theories of knowledge and justification have looked insuperable. Reliability is a property of the process of belief formation. But the generality problem apparently makes the specification of any such process ambiguous. The externalism of reliability theories clashes with strongly internalist intuitions. The reliability property does not appear closed under truth-preserving inference, whereas closure principles have strong intuitive appeal. And epistemic paradoxes, like the preface and the lottery, seem unavoidable if knowledge or justification depends on the frequency with (...) which a process generates true beliefs. The present theory has the conceptual resources to meet these challenges. It requires that a justificatory belief-formation process be intentionally applied. It distinguishes the justification of beliefs from that of the believer. And it avoids a frequency interpretation of reliability by introducing a notion of the normalcy of conditions under which processes are intentionally used. (shrink)

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this (...) case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. (shrink)

On this occasion, and in this place, I feel that I ought, and am probably expected, to look back at the things which have happened to the philosophy of science since I first began to take an interest in it over half a century ago. But I am both too much an outsider and too much a protagonist to undertake that assignment. Rather than attempt to situate the present state of philosophy of science with respect to its past — a (...) subject on which I’ve little authority — I shall try to situate my present state in philosophy of science with respect to its own past — a subject on which, however imperfect, I’m probably the best authority there is.As a number of you know, I’m at work on a book, and what I mean to attempt here is an exceedingly brief and dogmatic sketch of its main themes. I think of my project as a return, now underway for a decade, to the philosophical problems left over from the Structure of Scientific Revolutions. (shrink)

It has been argued extensively that diagnostic services are a general good, but that it is offered in excess. So what is the problem? Is not “too much of a good thing wonderful”, to paraphrase Mae West? This article explores such a possibility in the field of radiological services where it is argued that more than 40% of the examinations are excessive. The question of whether radiological examinations are excessive cries for a definition of diagnostic futility. However, no such definition (...) is found in the literature. As a response, this article addresses the issue of diagnostic futility in five steps. First, it investigates whether the concept of therapeutic futility can be adapted to diagnostics. A closer analysis of the concept of therapeutic futility reveals that this will not do the trick. Second, the article scrutinizes whether there are sources for clarifying diagnostic futility in the extensive debate on excessive radiological examination. Investigating the debate’s terms and definitions reveals a disparate terminology and no clear concepts. On the contrary, the study uncovers that quite different and incompatible issues are at stake. Third, the article examines a procedural approach, which is widely used for settling controversies over utility by focusing on the role of the professionals. On scrutiny however, a procedural approach will not solve the problem in diagnostics. Fourth, a value analysis reveals how we have to decide on the negative value of excessive examinations before we can measure excess. The final and constructive part presents a definition of diagnostic futility drawing upon the lessons from the previous analytical steps. Altogether, too much radiological examination is not a good thing. This is simply because radiological examinations are not unanimously good. Excessive radiological examinations can be defined, but not by one simple general and value-neutral definition. We have to settle with contextually framed value-related definitions. Such definitions will state how bad “too much of a good thing” is and make it possible to assess how much of the bad thing there is. Hence we have to know how bad it is before we can tell how much of it there is in the world. (shrink)

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, the concept of (...) ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge. (shrink)

Given that many imaging technologies in biology and medicine are non-optical and generate data that is essentially numerical, it is a striking feature of these technologies that the data generated using them are most frequently displayed in the form of semi-naturalistic, photograph-like images. In this paper, I claim that three factors underlie this: (1) historical preferences, (2) the rhetorical power of images, and (3) the cognitive accessibility of data presented in the form of images. The third of these can be (...) argued to provide an epistemic advantage to images, but I will further argue that this is often misleading and that images can in many cases be less informative than the corresponding mathematical data. (shrink)

This chapter contains sections titled: Introduction Neglecting Experiment; Distorting Observation The Socio‐Theoretical Turn Some Issues for Empirical Epistemologists.

How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

Scientific concepts, laws, theories, models and thought experiments are representations but uniquely different. In On Scientific Representation each is given a full philosophical exploration within an original, coherent philosophical framework that is strongly rooted in the Kantian tradition (Kant, Hertz, Vaihinger, Cassirer). Through a revisionist historical approach, Boniolo shows how the Kantian tradition can help us renew and rethink contemporary issues in epistemology and the philosophy of science.

One of the main goals of epistemologists is to provide a substantive and explanatory account of the conditions under which a belief has some desirable epistemic status (typically, justification or knowledge). According to the reliabilist approach to epistemology, any adequate account will need to mention the reliability of the process responsible for the belief, or truth-conducive considerations more generally. Historically, one major motivation for reliabilism—and one source of its enduring interest—is its naturalistic potential. According to reliabilists, epistemic properties can be (...) explained in terms of reliability, which in turn can be understood without reference to any unreduced epistemic notions, such as evidence or knowledge. This article begins by surveying some of the main forms of reliabilism, concentrating on process reliabilism as a theory of justification. It proceeds to review some of the main objections to reliabilism, and some of the responses that have been offered on the reliabilist’s behalf. After canvassing some recent developments in reliabilist epistemology, the article concludes by considering various cousins and spin-offs of reliabilist epistemology, including virtue reliabilism and various evidentialist-reliabilist hybrids. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

A highly condensed account of the author's present view of some philosophical problems unresolved in The Structure of Scientific Revolutions. The concept of incommensurability, now considerably developed, remains at center stage, but the evolutionary metaphor, introduced in the final pages of the book, now also plays a principal role.

A highly condensed account of the author's present view of some philosophical problems unresolved in The Structure of Scientific Revolutions. The concept of incommensurability, now considerably developed, remains at center stage, but the evolutionary metaphor, introduced in the final pages of the book, now also plays a principal role.