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)

Two approaches to evidential reasoning compete in the biomedical and social sciences: the experimental and the pragmatist. Whereas experimentalism has received considerable philosophical analysis and support since the times of Bacon and Mill, pragmatism about evidence has been neither articulated nor defended. The overall aim is to fill this gap and develop a theory that articulates the latter. The main ideas of the theory will be illustrated and supported by a case study on the smoking/lung cancer controversy in the 1950s.

The general goal is to encourage informal logicians and those interested in applied epistemology to look at epidemiology as a paradigmatic science crucially dependant on argumentation to justify its claims. Three specific goals are: 1. exemplify applied epistemology by looking critically at causal argumentation in epidemiology, 2. show that justification of causal claims in epidemiology is a form of “argument to the best explanation,” 3. show that there could be a symbiotic relationship between epidemiology and work in various applied reasoning (...) disciplines such as argumentation and “applied epistemology.”. (shrink)

This paper attempts to elucidate three characteristics of causal relationships that are important in biological contexts. Stability has to do with whether a causal relationship continues to hold under changes in background conditions. Proportionality has to do with whether changes in the state of the cause “line up” in the right way with changes in the state of the effect and with whether the cause and effect are characterized in a way that contains irrelevant detail. Specificity is connected both to (...) David Lewis’ notion of “influence” and also with the extent to which a causal relation approximates to the ideal of one cause–one effect. Interrelations among these notions and their possible biological significance are also discussed. (shrink)

In this paper, we analyse the fruitfulness of Ronald Giere’s comparative model for causation in populations. While the original model was primarily developed to capture the meaning of causal claims in the biomedical and health sciences, we want to show that the model is not only useful in these domains, but can also fruitfully be applied to other scientific domains. Specifically, we demonstrate that the model is fruitful for characterizing the meaning of causal claims found in classical genetics, epidemiology and (...) electoral sociology. Additionally, we propose an adapted comparative model which is needed to get a grip on higher level causal claims. We show that such claims are present in population genetics, epidemiology and electoral systems research. We conclude with some reflections on the implications of our findings for the issue of causal pluralism. (shrink)

The goal of research in social epidemiology is not simply conceptual clarification or theoretical understanding, but more importantly it is to contribute to, and enhance the health of populations (and so, too, the people who constitute those populations). Undoubtedly, understanding how various individual risk factors such as smoking and obesity affect the health of people does contribute to this goal. However, what is distinctive of much on-going work in social epidemiology is the view that analyses making use of individual-level variables (...) is not enough. In the spirit of Durkheim and Weber, S. Leonard Syme makes this point by writing that just “as bad water and food may be harmful to our health, unhealthful forces in our society may be detrimental to our capacity to make choices and to form opinions” conducive to health and well-being. Advocates of upstream (distal) causes of adverse health outcomes propose to identify the most important of these “unhealthful forces” as the fundamental causes of adverse health outcomes. However, without a clear, theoretically precise and well-grounded understanding of the characteristics of fundamental causes, there is little hope in applying the statistical tools of the health sciences to hypotheses about fundamental causes, their outcomes, and policies intended to enhance the health of populations. This paper begins the process of characterizing the social epidemiological concept of fundamental cause in a theoretically respectable and robust way. (shrink)

Epidemiologists’ discussions on causation are not always very enlightening with regard to the notion of ‘cause’ in epidemiology. Epidemiologists rightly work from a science-based approach to causation in epidemiology, but largely disagree about the matter. Disagreement may be partly due to confusion of the question of useful concepts for causal inference in epidemiological practice with the question of the metaphysical presuppositions of causal concepts used in epidemiology. In other words, epidemiologists seem to confuse the practical results of epidemiological research at (...) the population level with the metaphysical views about the reality of disease causation at the individual level in their writings on causation. (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 ...

A leading international expert on environmental issues, Shrader-Frechette brings a new standard of rigor to philosophical discussions of environmental justice in her latest work. Observing that environmental activists often value environmental concerns over basic human rights, she points out the importance of recognising that minority groups and the poor in general are frequently the biggest victims of environmental degradation, a phenomenon with serious social and political implications that the environmental movement has failed to adequately address. She argues for their equal (...) rights to 'environmental justice' and maintains that they should not have to bear most of the weight of the burdens of pollution and resource depletion. Advocating a greater awareness on the part of professionals in a position to help these victims, Shrader-Frechette proposes a more equitable distribution of environmental resources and, in doing so, makes an important contribution to the fields of environmental ethics and applied philosophy. (shrink)

Critics of the Implicit Association Test —a measure of the strength of a person’s automatic, memory-based association between two concepts, such as “black” and “threatening” or “white” and “caring”—have at least three main objections. Their symmetry argument is that the IAT should but does not give equally valid results for black-on-white and white-on-black racism. Their cultural-awareness argument is that the IAT illegitimately presupposes that use of racial stereotypes presupposes no stereotype acceptance, only stereotype awareness. Their completeness argument is that at (...) best the IAT measures only questionable or implicit, not explicit, bias because IAT ignores the fact that subjects’ conscious desires to avoid bias often enable them to check their biased behavior. Examining each of these anti-IAT stances, the paper summarizes the IAT and then argues for 6 main claims. Clarifying concepts like racism is important for progress in social science. IAT critics’ SA presupposes an ahistorical/acultural concept of racism. IAT critics’ AA presupposes a linguistically-insensitive concept of racism, one presupposing that the language we use provides no behavioral evidence for racism. IAT critics’ CA presupposes a concept of racism subject to conscious, deliberate control. IAT proponents endorse a more plausible concept of racism, one that is contextual, linguistically sensitive, and often not susceptible to conscious control. Although the IAT debate is unsettled, IAT critics’ use of a questionable concept of racism gives grounds for doubting their claims. (shrink)

This paper provides an argument for a more socially relevant philosophy of science (SRPOS). Our aims in this paper are to characterize this body of work in philosophy of science, to argue for its importance, and to demonstrate that there are significant opportunities for philosophy of science to engage with and support this type of research. The impetus of this project was a keen sense of missed opportunities for philosophy of science to have a broader social impact. We illustrate various (...) ways in which SRPOS can provide social benefits, as well as benefits to scientific practice and philosophy itself. Also, SRPOS is consistent with some historical and contemporary goals of philosophy of science. We’re calling for an expansion of philosophy of science to include more of this type of work. In order to support this expansion, we characterize philosophy of science as an epistemic community and examine the culture and practices of philosophy of science that can help or hinder research in this area. (shrink)

The paper examines definitions of ‘cause’ in the epidemiological literature. Those definitions all describe causes as factors that make a difference to the distribution of disease or to individual health status. In the philosophical jargon, causes in epidemiology are difference-makers. Two claims are defended. First, it is argued that those definitions underpin an epistemology and a methodology that hinge upon the notion of variation, contra the dominant Humean paradigm according to which we infer causality from regularity. Second, despite the fact (...) that causes be defined in terms of ‘difference-making’, this cannot fixes the causal metaphysics. Causality in epidemiology ought to be interpreted according to the epistemic theory. In this approach relations are deemed causal depending on the evidence and on the available methods. Indeed, evidence to establish causal claims requires difference-making considerations; furthermore, those definitions of cause reflect the ‘variational’ epistemology and methodology of epidemiology. (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)

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light of emerging issues and increased (...) scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment. (shrink)

The `fact' of pluralism in science is nosurprise. Yet, if science is representing andexplaining the structure of the oneworld, why is there such a diversity ofrepresentations and explanations in somedomains? In this paper I consider severalphilosophical accounts of scientific pluralismthat explain the persistence of bothcompetitive and compatible alternatives. PaulSherman's `Levels of Analysis' account suggeststhat in biology competition betweenexplanations can be partitioned by the type ofquestion being investigated. I argue that thisaccount does not locate competition andcompatibility correctly. I then defend anintegrative (...) model for understanding pluralism. This view is based on taking seriously both thecomplexity and contingency of biologicalorganization and the idealized character ofbiological models. On this view, explanationbecomes, among other things, the location forthe integration of diverse models. I explicatemy argument by an analysis of explanations ofdivision of labor in social insects. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

I argue that difference-making should be a crucial element for evaluating the quality of evidence for mechanisms, especially with respect to the robustness of mechanisms, and that it should take central stage when it comes to the general role played by mechanisms in establishing causal claims in medicine. The difference- making of mechanisms should provide additional compelling reasons to accept the gist of Russo-Williamson thesis and include mechanisms in the protocols for Evidence- Based Medicine (EBM), as the EBM+ research group (...) has been advocating. (shrink)

Epidemiologists’ discussions on causation are not always very enlightening with regard to the notion of ‘cause’ in epidemiology. Epidemiologists rightly work from a science-based approach to causation in epidemiology, but largely disagree about the matter. Disagreement may be partly due to confusion of the question of useful concepts for causal inference in epidemiological practice with the question of the metaphysical presuppositions of causal concepts used in epidemiology. In other words, epidemiologists seem to confuse the practical results of epidemiological research at (...) the population level with the metaphysical views about the reality of disease causation at the individual level in their writings on causation. (shrink)

Models of illness causation play a crucial role in medicine and public health. In their recent paper on this topic, Michael Kelly, Rachel Kelly, and Federica Russo state that the integration of social, biological, and behavioral causes in one and the same etiologic mechanism remains to be clarified. In particular, they think that current models of illness causation do not appreciate "the truly integrated nature of bio-social-behavioral pathogenesis". In brief, Kelly, Kelly, and Russo suggest that two levels of explanation are (...) at work in medicine and public health, biological and social; that integration is difficult because of resistance to including social determinants of disease in both the... (shrink)

This paper seeks to determine the significance, if any, of epidemiological evidence to prove the specific causation element of liability in negligence or other relevant torts—in particular, what importance can be attached to a relative risk > 2, where that figure represents a sound causal inference at the general level. The paper discusses increased risk approaches to epidemiological evidence and concludes that they are a last resort. The paper also criticizes the proposal that the probability of causation can be estimated (...) with reference to the RR, such that RR > 2 is necessary and sufficient for causation. It is argued, following arguments by Sander Greenland and others, that RR > 2 is not necessary for proof of specific causation, except under restrictive biological assumptions that are not known to be satisfied for any important disease, and therefore must never be required. However, the paper argues that in some circumstances RR > 2 can be sufficient to prove causation at law. This position is defended against the widely held judicial and academic view that epidemiological evidence must be accompanied by something else, particular to the case at hand, if it is to have probative force for specific causation. It is argued that far from being epistemically irrelevant, to achieve correct and just outcomes it is in fact mandatory to take epidemiological evidence into account in deciding specific causation. Failing to consider such evidence when it is available leads to error and injustice. The conclusion is that in certain circumstances epidemiological evidence of RR > 2 is not necessary to prove specific causation but that it is sufficient. This “sufficiency” is confined to circumstances where there is no other evidence, as a way of getting clear on what the epidemiological evidence says. Once we have worked out what it says, this must be weighed against the other relevant evidence, if there is any. (shrink)

If there is any value in the idea that disease is something other than the mere absence of health then that value must lie in the way that diseases are classified. This paper offers further development of a view advanced previously, the 'contrastive model' of disease: it develops the account to handle asymptomatic disease ; and in doing so it relates the model to a broadly biostatistical view of health. The developments are prompted by considering cancers featuring viruses as prominent (...) causes, since these appear to amount to cases where the prescriptions of the contrastive model could be followed, but aren't. The resulting irrelevance objection claims that the contrastive model is irrelevant to medical science and practice. The paper seeks to rebut the irrelevance objection. (shrink)

Nineteenth-century medical advances were entwined with a conceptual innovation: the idea that many cases of disease which were previously thought to have diverse causes could be explained by the action of a single kind of cause, for example a certain bacterial or parasitic infestation. The focus of modern epidemiology, however, is on chronic non-communicable diseases, which frequently do not seem to be attributable to any single causal factor. This paper is an effort to resolve the resulting tension. The paper criticises (...) the monocausal model of disease, so successful in the nineteenth century. It also argues that a multifactorial model of disease can only be satisfactory if it amounts to more than a mere rejection of the monocausal model. A third alternative, the contrastive model, is proposed and defended on the grounds that it links the notions of disease and of general explanation, while avoiding the philosophical naiveties and practical difficulties of the monocausal model. (shrink)

A world awash in little understood chemicals tragically harms adults and children alike. Laws keep health agencies in the dark about toxicants, slow, well motivated research hampers protections, and strenuous vested opposition exacerbates the harm. How science is used in the tort law can facilitate or frustrate redress of harm. This book recommends better approaches.

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational (...) issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)

Bryan W. Van Norden lambastes academic philosophy for its Eurocentrism and insularity and challenges educational institutions to live up to their cosmopolitan ideals. Taking Back Philosophy is at once a manifesto for multicultural education, an accessible introduction to Confucian and Buddhist philosophy, and a defense of the value of philosophy.

Argues for a transactionally situated approach to science and medicine in order to meet the needs of marginalized groups. -/- The Limits of Knowledge provides an understanding of what pragmatist feminist theories look like in practice, combining insights from the work of American pragmatist John Dewey concerning experimental inquiry and transaction with arguments for situated knowledge rooted in contemporary feminism. Using case studies to demonstrate some of the particular ways that dominant scientific and medical practices fail to meet the health (...) needs of marginalized groups and communities, Nancy Arden McHugh shows how transactionally situated approaches are better able to meet the needs of these communities. Examples include a community action group fighting environmental injustice in Bayview Hunters Point, California, one of the most toxic communities in the US; gender, race, age, and class biases in the study and diagnosis of endometriosis; a critique of Evidence-Based Medicine; the current effects of Agent Orange on Vietnamese women and children; and pediatric treatment of Amish and Mennonite children. (shrink)

This book explores a variety of conceptual and methodological questions about cancer and cancer research: Is cancer one disease, or many? If many, how many exactly? How is cancer classified? What does it mean, exactly, to say that cancer is “genetic,” or “familial”? What exactly are the causes of cancer, and how do scientists come to know about them? When do we have good reason to believe that this or that is a risk factor for cancer? How is cancer a (...) product or byproduct of multilevel evolution? Is cancer research unified? What sort of models, or theories, govern cancer research? This book takes a close look at these philosophical questions, by examining work in disciplines as diverse as cell and molecular biology, epidemiology, clinical medicine, and evolutionary biology. (shrink)

In this essay, I argue that Ted Poston's theory of explanatory coherentism is well-suited as a tool for causal explanation in the health sciences, particularly in epidemiology. Coherence has not only played a role in epidemiology for more than half a century as one of Hill's viewpoints, it can also provide background theory for the development of explanatory systems by integrating epidemiologic evidence with a diversity of other error-independent data. I propose that computational formalization of Hill's viewpoints in an explanatory (...) coherentist framework would provide an excellent starting point for a formal epistemological (knowledge-theoretical) project designed to improve causal explanation in the health sciences. As an example, I briefly introduce Paul Thagard's ECHO system and offer my responses to possible objections to my proposal. (shrink)