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)

In this important new study Ian Hacking continues the enquiry into the origins and development of certain characteristic modes of contemporary thought undertaken in such previous works as his best selling Emergence of Probability. Professor Hacking shows how by the late nineteenth century it became possible to think of statistical patterns as explanatory in themselves, and to regard the world as not necessarily deterministic in character. Combining detailed scientific historical research with characteristic philosophic breath and verve, The Taming of Chance (...) brings out the relations among philosophy, the physical sciences, mathematics and the development of social institutions, and provides a unique and authoritative analysis of the "probabilization" of the Western world. (shrink)