Includes bibliographical references and index. ISBN 0-226-595 19-6 (cloth : alk. paper) . A . 1. Environmental policy. 2. Environmental management — Decision making. 3. Interdisciplinary research. 4. Communication in science. 5. Sustainable ...

The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness -- Questioning (...) the methodological superiority of "placebo" over "active" controlled trials -- Examining the paradox that traditional roles for mechanistic reasoning and expert -- Judgment have been up-ended by EBM -- A qualified defence of the EBM stance on mechanistic reasoning -- Knowledge that versus knowledge how : situating the EBM position on expert clinical judgment -- Moving EBM forward. (shrink)

Critics of the ideal of value‐free science often assume that they must reject the distinction between epistemic and nonepistemic values. I argue that this assumption is mistaken and that the distinction can be used to clarify and defend the argument from inductive risk, which challenges the value‐free ideal. I develop the idea that the characteristic feature of epistemic values is that they promote, either intrinsically or extrinsically, the attainment of truths. This proposal is shown to answer common objections to the (...) distinction and provide a principled basis for separating legitimate from illegitimate influences of nonepistemic values in scientific inference. *Received June 2009; revised September 2009. †To contact the author, please write to: 503 S. Kedzie Hall, Michigan State University, East Lansing, MI 48824‐1032; e‐mail: [email protected]. (shrink)

Inferences like these are known as extrapolations.

Causality offers the first comprehensive coverage of causal analysis in many sciences, including recent advances using graphical methods. Pearl presents a unified account of the probabilistic, manipulative, counterfactual and structural approaches to causation, and devises simple mathematical tools for analyzing the relationships between causal connections, statistical associations, actions and observations. The book will open the way for including causal analysis in the standard curriculum of statistics, artificial intelligence, business, epidemiology, social science and economics.

Evidence-Based Medicine is a relatively new movement that seeks to put clinical med- icine on a firmer scientific footing. I take it as uncontroversial that medical practice should be based on best evidence-the interesting questions concern the details. This paper tries to move towards a coherent and unified account of best evidence in medicine, by exploring in particular the EBM position on RCTs (randomized controlled trials).

It is surely obvious that medicine, like any other rational activity, must be based on evidence. The interest is in the details: how exactly are the general principles of the logic of evidence to be applied in medicine? Focussing on the development, and current claims of the ‘Evidence-Based Medicine’ movement, this article raises a number of difficulties with the rationales that have been supplied in particular for the ‘evidence hierarchy’ and for the very special role within that hierarchy of randomized (...) controlled trials (and meta-analyses of the results of randomized controlled trials). The point is not at all to question the application of a scientific approach to evidence in medicine, but, on the contrary, to indicate a number of areas where philosophers of science can contribute to a proper implementation of exactly that scientific-evidential approach. (shrink)

We argue that the health sciences make causal claims on the basis of evidence both of physical mechanisms, and of probabilistic dependencies. Consequently, an analysis of causality solely in terms of physical mechanisms or solely in terms of probabilistic relationships, does not do justice to the causal claims of these sciences. Yet there seems to be a single relation of cause in these sciences - pluralism about causality will not do either. Instead, we maintain, the health sciences require a theory (...) of causality that unifies its mechanistic and probabilistic aspects. We argue that the epistemic theory of causality provides the required unification. (shrink)

The question of the relationship of the making of value judgments in a typically ethical sense to the methods and procedures of science has been discussed in the literature at least to that point which e. e. cummings somewhere refers to as “The Mystical Moment of Dullness.” Nevertheless, albeit with some trepidation, I feel that something more may fruitfully be said on the subject.

“[T]he Precautionary Principle still has neither a commonly accepted definition nor a set of criteria to guide its implementation. “There is”, Freestone … cogently observes, “a certain paradox in the widespread and rapid adoption of the Precautionary Principle”: While it is applauded as a “good thing”, no one is quite sure about what it really means or how it might be..

We are living in a climate of risk. Our way of life imposes risks on ourselves and others. We are causing climatic changes that have the potential to change radically the conditions under which both we - the presentgeneration - and future generations will live. While we are now quite certain that climate change is happening, we are unsure of exactly what will happen and when, given different emissions and policy scenarios. We are therefore in a position where we must (...) decide what to do about the risks climate change threatens in the face of a range of uncertainties In this book, Lauren Hartzell-Nichols provides guidance in the face of this uncertainty by offering an in-depth discussion of how and why we ought to take a precautionary approach to climate policy, namely by appeal to a Catastrophic Precautionary Principle and Catastrophic Precautionary Decision-Making Framework. By examining the way in which climate change is harmful, Hartzell-Nichols shows how precaution does have a meaningful role to play in moving climate policy forward if we reconsider what precaution is about before too quickly appealing to precaution as a reason or justification for action. A Climate of Risk takes a philosophically grounded, interdisciplinary approach that will appeal to a broad scholarly and policy-oriented audience. Hartzell-Nichols's reinterpretation of the precautionary principle enables precaution to be more effectively leveraged as a driver of action on climate change. (shrink)

This article critically examines a recent philosophical debate on the role of values in climate change forecasts, such as those found in assessment reports of the Intergovernmental Panel on Climate Change. On one side, several philosophers insist that the argument from inductive risk, as developed by Rudner and Douglas among others, applies to this case. AIR aims to show that ethical value judgments should influence decisions about what is sufficient evidence for accepting scientific hypotheses that have implications for policy issues. (...) Advocates of extending AIR to climate science claim that values are deeply... (shrink)

An astonishing volume and diversity of evidence is available for many hypotheses in the biomedical and social sciences. Some of this evidence—usually from randomized controlled trials (RCTs)—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not RCTs are the ‘gold-standard’ of evidence, it is usually meta-analysis which is considered the best source of evidence: meta-analysis is thought by many to be the platinum standard of evidence. However, I argue that meta-analysis falls far short of that standard. Different meta-analyses (...) of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for intersubjective assessments of hypotheses because numerous decisions must be made when performing a meta-analysis which allow wide latitude for subjective idiosyncrasies to influence its outcome. I end by suggesting that an older tradition of evidence in medicine—the plurality of reasoning strategies appealed to by the epidemiologist Sir Bradford Hill—is a superior strategy for assessing a large volume and diversity of evidence. (shrink)

Evidence-Based Medicine is a relatively new movement that seeks to put clinical medicine on a firmer scientific footing. I take it as uncontroversial that medical practice should be based on best evidence—the interesting questions concern the details. This paper tries to move towards a coherent and unified account of best evidence in medicine, by exploring in particular the EBM position on RCTs.

Scholars in philosophy, law, economics and other fields have widely debated how science, environmental precaution, and economic interests should be balanced in urgent contemporary problems, such as climate change. One controversial focus of these discussions is the precautionary principle, according to which scientific uncertainty should not be a reason for delay in the face of serious threats to the environment or health. While the precautionary principle has been very influential, no generally accepted definition of it exists and critics charge that (...) it is incoherent or hopelessly vague. This book presents and defends an interpretation of the precautionary principle from the perspective of philosophy of science, looking particularly at how it connects to decisions, scientific procedures, and evidence. Through careful analysis of numerous case studies, it shows how this interpretation leads to important insights on scientific uncertainty, intergenerational justice, and the relationship between values and policy-relevant science. (shrink)

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.

In recent years, the argument from inductive risk against value free science has enjoyed a revival. This paper investigates and clarifies this argument through means of a case-study: neonicitinoid research. Sect. 1 argues that the argument from inductive risk is best conceptualised as a claim about scientists’ communicative obligations. Sect. 2 then shows why this argument is inapplicable to “public communication”. Sect. 3 outlines non-epistemic reasons why non-epistemic values should not play a role in public communicative contexts. Sect. 4 analyses (...) the implications of these arguments both for the specific case of neonicitinoid research and for understanding the limits of the argument from inductive risk. Sect. 5 sketches the broader implications of my claims for understanding the “Value Free Ideal” for science. (shrink)

Since a couple of decades, the notion of a precautionary principle plays a central and increasingly influential role in international as well as national policy and regulation regarding the environment and the use of technology. Urging society to take action in the face of potential risks of human activities in these areas, the recent focus on climate change has further sharpened the importance of this idea. However, the idea of a precautionary principle has also been problematised and criticised by scientists, (...) scholars and policy activists, and been accused of almost every intellectual sin imaginable: unclarity, impracticality, arbitrariness and moral as well as political unsoundness. In that light, the very idea of precaution as an ideal for policy making rather comes out as a dead end. On the basis of these contrasting starting points, Christian Munthe undertakes an innovative, in-depth philosophical analysis of what the idea of a precautionary principle is and should be about. A novel theory of the ethics of imposing risks is developed and used as a foundation for defending the idea of precaution in environmental and technological policy making against its critics, while at the same time avoiding a number of identified flaws. The theory is shown to have far-reaching consequences for areas such as bio-, information- and nuclear technology, and global environmental policy in areas such as climate change. The author argues that, while the price we pay for precaution must not be too high, we have to be prepared to pay it in order to act ethically defensible. A number of practical suggestions for precautionary regulation and policy making are made on the basis of this, and some challenges to basic ethical theory as well as consumerist societies, the global political order and liberal democracy are identified. (shrink)

Two interpretations of the precautionary principle are considered. According to the normative interpretation, the precautionary principle should be characterised in terms of what it urges doctors and other decision makers to do. According to the epistemic interpretation, the precautionary principle should be characterised in terms of what it urges us to believe. This paper recommends against the use of the precautionary principle as a decision rule in medical decision making, based on an impossibility theorem presented in Peterson . However, the (...) main point of the paper is an argument to the effect that decision theoretical problems associated with the precautionary principle can be overcome by paying greater attention to its epistemic dimension. Three epistemic principles inherent in a precautionary approach to medical risk analysis are characterised and defended. (shrink)

The precautionary principle (PP) has been criticised for almost every intellectual sin one may imagine: unclarity, impracticability, rigidity, implausibility etc. Recognising the rather obvious fact that there is no such thing as one PP, this paper attempts to address this criticism on a more constructive note than merely view it as forcing us to be "for or against" precaution. This is done by connecting an underlying ethical ideal regarding the imposition of risks present in most formulations of PP to the (...) criticism and use the latter for discussing how such an idea may be plausibly designed and used for underpinning policies that may plausibly be said to express the spirit of PP. It is argued that the most important issue regarding this is to recognise that there is something to the idea that imposing risks on people has a morally significant price, but that we must also acknowledge that taking precautionary measures to avoid or decrease such risks has such a price. The critical issue in the ethics of risk of relevance for PP thus becomes what constitutes a proper price of precaution. It is demonstrated how two simple constraints on this amkes it easy to meet many typical arguments against PP, but also how this issue must be further attacked by means transcending the traditional tools of normative ethics and decision theory, as well as how further reflection along such lines connects PP to issues of international.. (shrink)

Philosophical discussions on causal inference in medicine are stuck in dyadic camps, each defending one kind of evidence or method rather than another as best support for causal hypotheses. Whereas Evidence Based Medicine advocates the use of Randomised Controlled Trials and systematic reviews of RCTs as gold standard, philosophers of science emphasise the importance of mechanisms and their distinctive informational contribution to causal inference and assessment. Some have suggested the adoption of a pluralistic approach to causal inference, and an inductive (...) rather than hypothetico-deductive inferential paradigm. However, these proposals deliver no clear guidelines about how such plurality of evidence sources should jointly justify hypotheses of causal associations. We here develop such guidelines by first giving a philosophical analysis of the underpinnings of Hill’s viewpoints on causality. We then put forward an evidence-amalgamation framework adopting a Bayesian net approach to model causal inference in pharmacology for the assessment of harms. Our framework accommodates a number of intuitions already expressed in the literature concerning the EBM vs. pluralist debate on causal inference, evidence hierarchies, causal holism, relevance, and reliability. (shrink)

In this book, Carl Cranor utilizes material from ethics, philosophy of law, epidemiology, tort law, regulatory law, and risk assessment to argue that the evidentiary standards for science used in the law to control toxics ought to be ...

What is the relationship between fear, danger, and the law? Cass Sunstein attacks the increasingly influential Precautionary Principle - the idea that regulators should take steps to protect against potential harms, even if causal chains are uncertain and even if we do not know that harms are likely to come to fruition. Focusing on such problems as global warming, terrorism, DDT, and genetic engineering, Professor Sunstein argues that the Precautionary Principle is incoherent. Risks exist on all sides of social situations, (...) and precautionary steps create dangers of their own. Diverse cultures focus on very different risks, often because social influences and peer pressures accentuate some fears and reduce others. Instead of adopting the Precautionary Principle, Professor Sunstein argues for three steps: a narrow Anti-Catastrophe Principle, designed for the most serious risks; close attention to costs and benefits; and an approach called 'libertarian paternalism', designed to respect freedom of choice while also moving people in directions that will make their lives go better. He also shows how free societies can protect liberty amidst fears about terrorism and national security. Laws of Fear represents a major statement from one of the most influential political and legal theorists writing today. (shrink)

The world is complex, but acknowledging its complexity requires an appreciation for the many roles context plays in shaping natural phenomena. In _Unsimple Truths, _Sandra Mitchell argues that the long-standing scientific and philosophical deference to reductive explanations founded on simple universal laws, linear causal models, and predict-and-act strategies fails to accommodate the kinds of knowledge that many contemporary sciences are providing about the world. She advocates, instead, for a new understanding that represents the rich, variegated, interdependent fabric of many levels (...) and kinds of explanation that are integrated with one another to ground effective prediction and action. Mitchell draws from diverse fields including psychiatry, social insect biology, and studies of climate change to defend “integrative pluralism”—a theory of scientific practices that makes sense of how many natural and social sciences represent the multi-level, multi-component, dynamic structures they study. She explains how we must, in light of the now-acknowledged complexity and contingency of biological and social systems, revise how we conceptualize the world, how we investigate the world, and how we act in the world. Ultimately _Unsimple Truths _argues that the very idea of what should count as legitimate science itself should change. (shrink)