This paper argues that significant aspects of the vaccination debate are ‘deep’ in a sense described by Robert Fogelin and others. Some commentators have suggested that such disagreements warrant rather threatening responses. I argue that appreciating that a disagreement is deep might have positive implications, changing our moral assessment of individuals and their decisions, shedding light on the limits of the obligation to give and respond to arguments in cases of moral disagreement, and providing an incentive to seek alternative ways (...) of going on in the face of intractable moral disagreement. Non-coercive, non-reasoned strategies have been used or recommended to increase vaccination rates. Such strategies look problematic when judged by the standards of ideal moral and rational argumentation, but more acceptable if seen as responses to deep disagreements. (shrink)

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. (...) Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal. (shrink)

Randomized controlled trials (RCTs) are widely taken as the gold standard for establishing causal conclusions. Ideally conducted they ensure that the treatment ‘causes’ the outcome—in the experiment. But where else? This is the venerable question of external validity. I point out that the question comes in two importantly different forms: Is the specific causal conclusion warranted by the experiment true in a target situation? What will be the result of implementing the treatment there? This paper explains how the probabilistic theory (...) of causality implies that RCTs can establish causal conclusions and thereby provides an account of what exactly that causal conclusion is. Clarifying the exact form of the conclusion shows just what is necessary for it to hold in a new setting and also how much more is needed to see what the actual outcome would be there were the treatment implemented. (shrink)

The claims of RCTs to be the gold standard rest on the fact that the ideal RCT is a deductive method: if the assumptions of the test are met, a positive result implies the appropriate causal conclusion. This is a feature that RCTs share with a variety of other methods, which thus have equal claim to being a gold standard. This paper describes some of these other deductive methods and also some useful non-deductive methods, including the hypothetico-deductive method. It argues (...) that with all deductive methods, the benefit that the conclusions follow deductively in the ideal case comes with a great cost: narrowness of scope. This is an instance of the familiar trade-off between internal and external validity. RCTs have high internal validity but the formal methodology puts severe constraints on the assumptions a target population must meet to justify exporting a conclusion from the test population to the target. The paper reviews one such set of assumptions to show the kind of knowledge required. The overall conclusion is that to draw causal inferences about a target population, which method is best depends case-by-case on what background knowledge we have or can come to obtain. There is no gold standard. (shrink)