The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of (...) clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine. (shrink)

Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing (...) is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Harry Collins’ book Tacit and Explicit Knowledge seeks to clarify the concept of tacit knowledge made famous by Michael Polanyi. Collins’ tripartite taxonomy of tacit knowledge is explained using illustrative examples from clinical medicine. Collins focuses on distinguishing the kinds of tacit knowledge that can (in principle) be made wholly explicit from the kinds of tacit knowledge that are inescapably tacit. Polanyi’s writings, on the other hand, emphasize the process of tacit knowing. Collins’ investigation of tacit knowledge makes an important (...) scholarly contribution that is distinct from and complementary to investigations that focus on tacit knowing. (shrink)

In recent years, the opioid crisis in the United States has sparked significant discussion on doctor–patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when describing (...) chronic pain, narrating symptoms and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions. (shrink)

Selection bias? Content Type Journal Article DOI 10.1007/s11016-010-9490-4 Authors Henry M. Cowles, Program in History of Science, Princeton University, Princeton, NJ 08544, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796.

This book addresses what it means to teach and learn ethics. While teaching ethics is universally applauded, how one goes about it is much more difficult and contested than is often recognized. The approach of the work is historical, philosophical, and theological. It begins with the historical transformation in the mid nineteenth century by Henry Sidgwick, who rejected establishing ethics on theology or metaphysics. G. E. Moore, John Rawls, Thomas Hurka, Bart Schultz, and Peter Singer later explicitly developed ethics (...) indebted to Sidgwick. However, G. E. M. Anscombe and Philippa Foot's important interventions in modern moral philosophy opened new possibilities for teaching and learning ethics that bear strong resemblances to pre-Sidgwick moral philosophy. The common thread between them is Thomas Aquinas, who had a different understanding of human action than Sidgwick. For Aquinas, Foot, and Anscombe, ethics does not concern a procedure to guide action to what is right or what ought to be, but exists within a metaphysical and theological realm in which the good is more basic than the right. The good is attractive so desire for it is an essential element of the moral life. (shrink)

Berkeley's immaterialism has more in common with views developed by Henry More, the mathematician Joseph Raphson, John Toland, and Jonathan Edwards than those of thinkers with whom he is commonly associated (e.g., Malebranche and Locke). The key for recognizing their similarities lies in appreciating how they understand St. Paul's remark that in God "we live and move and have our being" as an invitation to think to God as the space of discourse in which minds and ideas are identified. (...) This way of speaking about God, adapted by Karl Barth and Paul Tillich, opens up new ways to think about the relation between God and finite minds. (shrink)

Science and the End of Ethics examines some of the most important positive and negative implications that science has for ethics. Addressing the negative implications first, author Stephen Morris discusses how contemporary science provides significant challenges to moral realism. One threat against moral realism comes from evolutionary theory, which suggests that our moral beliefs are unconnected to any facts that would make them true. Ironically, many of the same areas of science (e.g. evolutionary biology, neuroscience, psychology) that present difficulties (...) for moral realism point to a new ethical approach that focuses on achieving some of the key practical goals shared by ethicists. Chief among these is how to increase amicable behavior among people. (shrink)

Historically, the scientific method has been said to require proposing a theory, making a prediction of something not already known, testing the prediction, and giving up the theory (or substantially changing it) if it fails the test. A theory that leads to several successful predictions is more likely to be accepted than one that only explains what is already known but not understood. This process is widely treated as the conventional method of achieving scientific progress, and was used throughout the (...) twentieth century as the standard route to discovery and experimentation. But does science really work this way? In Making 20th Century Science, Stephen G. Brush discusses this question, as it relates to the development of science throughout the last century. Answering this question requires both a philosophically and historically scientific approach, and Brush blends the two in order to take a close look at how scientific methodology has developed. Several cases from the history of modern physical and biological science are examined, including Mendeleev's Periodic Law, Kekule's structure for benzene, the light-quantum hypothesis, quantum mechanics, chromosome theory, and natural selection. In general it is found that theories are accepted for a combination of successful predictions and better explanations of old facts. Making 20th Century Science is a large-scale historical look at the implementation of the scientific method, and how scientific theories come to be accepted. (shrink)

_ Consequentialism_ collects, for the first time, both the main classical sources and the central contemporary expressions of this important position. Edited and introduced by Stephen Darwall, these readings are essential for anyone interested in normative ethics. Edited and introduced by Stephen Darwall, examines key topics in the consequentialist branch of moral theory. Includes seven essays which respond to the classic sources. Includes an insightful discussion of central topics in consequentialism by John Rawls and Amartya Sen. Includes classic (...) articles by key figures such Jeremy Bentham, John Stuart Mill, Henry Sidgwick and G. E. Moore; and recent reactions to this work by philosophers including Philip Pettit, Derek Parfit, Samuel Scheffler, Peter Railton, R. B. Brandt, J. C. Harsanyi, and Robert Adams. (shrink)

_ _ _Consequentialism_ collects, for the first time, both the main classical sources and the central contemporary expressions of this important position. Edited and introduced by Stephen Darwall, these readings are essential for anyone interested in normative ethics. Edited and introduced by Stephen Darwall, examines key topics in the consequentialist branch of moral theory. Includes seven essays which respond to the classic sources. Includes an insightful discussion of central topics in consequentialism by John Rawls and Amartya Sen. Includes (...) classic articles by key figures such Jeremy Bentham, John Stuart Mill, Henry Sidgwick and G. E. Moore; and recent reactions to this work by philosophers including Philip Pettit, Derek Parfit, Samuel Scheffler, Peter Railton, R. B. Brandt, J. C. Harsanyi, and Robert Adams. (shrink)

In recent years, several remarkable results have shown that certain theorems of finite combinatorics are unprovable in certain logical systems. These developments have been instrumental in stimulating research in both areas, with the interface between logic and combinatorics being especially important because of its relation to crucial issues in the foundations of mathematics which were raised by the work of Kurt Godel. Because of the diversity of the lines of research that have begun to shed light on these issues, there (...) was a need for a comprehensive overview which would tie the lines together. This volume fills that need by presenting a balanced mixture of high quality expository and research articles that were presented at the August 1985 AMS-IMS-SIAM Joint Summer Research Conference, held at Humboldt State University in Arcata, California.With an introductory survey to put the works into an appropriate context, the collection consists of papers dealing with various aspects of 'unprovable theorems and fast-growing functions'. Among the topics addressed are: ordinal notations, the dynamical systems approach to Ramsey theory, Hindman's finite sums theorem and related ultrafilters, well quasiordering theory, uncountable combinatorics, nonstandard models of set theory, and a length-of-proof analysis of Godel's incompleteness theorem. Many of the articles bring the reader to the frontiers of research in this area, and most assume familiarity with combinatorics and/or mathematical logic only at the senior undergraduate or first-year graduate level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Disputing the Unity of the World: The Importance of Res and the Influence of Averroes in Giles of Rome’s Critique of Thomas Aquinas concerning the Unity of the WorldG. J. Mcaleer1. introductiongiles of rome (1243–1316) earned, after a decidedly difficult start, the most complete honors open to an academic religious in the Middle Ages. Joining the Hermits of St. Augustine at age 14, he became the first regent master (...) of his order at the University of Paris (1285–1291); his works were made compulsory in the education of students entering the Hermits in 1287; finally, in 1292 he became the general of the order itself.1 Giles is significant, as Mandonnet puts it, because he “est incontestablement au premier rang des théologiens de la fin du XIIIe siècle.”2 But this is not all. Giles is also important to the period because his writings were censured by the same commission that composed the famous Parisian condemnation of 1277. As a result of this [End Page 29] censure, Giles had to leave Paris, returning only in 1285.3 Perhaps of even greater significance is the fact that his teacher was Thomas Aquinas: Giles studied with Thomas at Paris during the years 1269–1272.4 It has been acknowledged for a long time now that Giles did not slavishly follow his teacher but wrought his own subtle and wide-ranging philosophical synthesis out of the various grand traditions of medieval thought.5 As the critical editions of Giles’s works appear (an enormous task currently moving forward under the guidance of F. Del Punta and G. Fioravanti) it will become clearer on how many issues Giles saw fit to criticize the positions of Thomas. It is one of these issues, Giles’s dispute with Thomas over the unity of the matter of the universe, that I wish to elaborate and analyze in this essay.6The thirteenth century is surely one of the greatest for philosophical innovation. Thinkers of the stature of Albert the Great, Bonaventure, Thomas Aquinas, Henry of Ghent, and Giles of Rome engaged great metaphysical themes ranging from the unity of being and creation to the composition of material substances. These speculations were prompted by their efforts to systematize the vast theological heritage of Christian thought and their encounter with the rich and varied traditions of Greek, Islamic, and Jewish thought newly entering the Latin West in translation. Questions involving matter were especially common amongst these speculations, carrying special significance in that they redounded upon conceptions of human nature and thus upon the Incarnation and Resurrection. Moreover, disputes about matter demanded arduous thought on the interrelations of the fundamental metaphysical notions of the period: act and potency; substance and accident; generation and corruption; essence and existence; principle and thing; and so on. The productivity of these thinkers, and the range and complexity of the [End Page 30] questions they treated, was stunning, and ultimately led to a massive condemnation of 219 philosophical and theological propositions at the University of Paris in 1277. The Bishop of Paris, Stephen Tempier, with the aid of a theological commission that included Henry of Ghent, hoped to efface certain errors contained in these speculations. A large number of the condemned propositions were associated with Siger of Brabant and other so-called “Radical Aristotelians.” However, theses found in the works of Aquinas were included, and, as already mentioned, Tempier soon turned his attention to Giles of Rome.7A dominant issue throughout the condemnations and the works of the period, especially in questions concerning matter, is that of unicity and plurality. This is true of perhaps the two most famous debates: whether human nature is a composition of one or many forms and whether the intellect is one for all human persons. The latter is probably the most studied of all the disputes of that time and the controversy most often associated with Averroes. The question of whether there is one matter in the universe or two is very much connected with the plurality of forms debate. Regarding this debate, thinkers wanted to know not only the number of forms in material composites but also what material... (shrink)

We investigate the provability or nonprovability of certain ordinary mathematical theorems within certain weak subsystems of second order arithmetic. Specifically, we consider the Cauchy/Peano existence theorem for solutions of ordinary differential equations, in the context of the formal system RCA 0 whose principal axioms are ▵ 0 1 comprehension and Σ 0 1 induction. Our main result is that, over RCA 0 , the Cauchy/Peano Theorem is provably equivalent to weak Konig's lemma, i.e. the statement that every infinite {0, 1}-tree (...) has a path. We also show that, over RCA 0 , the Ascoli lemma is provably equivalent to arithmetical comprehension, as is Osgood's theorem on the existence of maximum solutions. At the end of the paper we digress to relate our results to degrees of unsolvability and to computable analysis. (shrink)

A mass problem is a set of Turing oracles. If P and Q are mass problems, we say that P is weakly reducible to Q if every member of Q Turing computes a member of P. We say that P is strongly reducible to Q if every member of Q Turing computes a member of P via a fixed Turing functional. The weak degrees and strong degrees are the equivalence classes of mass problems under weak and strong reducibility, respectively. We (...) focus on the countable distributive lattices P w and P s of weak and strong degrees of mass problems given by nonempty Π 1 0 subsets of 2 ω . Using an abstract Gödel/Rosser incompleteness property, we characterize the Π 1 0 subsets of 2 ω whose associated mass problems are of top degree in P w and P s , respectively. Let R be the set of Turing oracles which are random in the sense of Martin-Löf, and let r be the weak degree of R. We show that r is a natural intermediate degree within P w . Namely, we characterize r as the unique largest weak degree of a Π 1 0 subset of 2 ω of positive measure. Within P w we show that r is meet irreducible, does not join to 1, and is incomparable with all weak degrees of nonempty thin perfect Π 1 0 subsets of 2 ω . In addition, we present other natural examples of intermediate degrees in P w . We relate these examples to reverse mathematics, computational complexity, and Gentzen-style proof theory. (shrink)

Let ω be the set of natural numbers. For functions f, g: ω → ω, we say f is dominated by g if f < g for all but finitely many n ∈ ω. We consider the standard “fair coin” probability measure on the space 2ω of in-finite sequences of 0's and 1's. A Turing oracle B is said to be almost everywhere dominating if, for measure 1 many X ∈ 2ω, each function which is Turing computable from X is (...) dominated by some function which is Turing computable from B. Dobrinen and Simpson have shown that the almost everywhere domination property and some of its variant properties are closely related to the reverse mathematics of measure theory. In this paper we exposit some recent results of Kjos-Hanssen, Kjos-Hanssen/Miller/Solomon, and others concerning LR-reducibility and almost everywhere domination. We also prove the following new result: If B is almost everywhere dominating, then B is superhigh, i. e., 0″ is truth-table computable from B ′, the Turing jump of B. (shrink)

An examination of verbal hallucinations and thought insertion as examples of "alienated self-consciousness.".

We investigate the reverse-mathematical status of several theorems to the effect that the natural number system is second-order categorical. One of our results is as follows. Define a system to be a triple A,i,f such that A is a set and i∈A and f:A→A. A subset X⊆A is said to be inductive if i∈X and ∀a ∈X). The system A,i,f is said to be inductive if the only inductive subset of A is A itself. Define a Peano system to be (...) an inductive system such that f is one-to-one and i∉the range of f. The standard example of a Peano system is N,0,S where N={0,1,2,…,n,…}=the set of natural numbers and S:N→N is given by S=n+1 for all n∈N. Consider the statement that all Peano systems are isomorphic to N,0,S. We prove that this statement is logically equivalent to WKL0 over RCA0⁎ source. From this and similar equivalences we draw some foundational/philosophical consequences. (shrink)

Let CKDT be the assertion that for every countably infinite bipartite graph G, there exist a vertex covering C of G and a matching M in G such that C consists of exactly one vertex from each edge in M. (This is a theorem of Podewski and Steffens [12].) Let ATR0 be the subsystem of second-order arithmetic with arithmetical transfinite recursion and restricted induction. Let RCA0 be the subsystem of second-order arithmetic with recursive comprehension and restricted induction. We show that (...) CKDT is provable in ART0. Combining this with a result of Aharoni, Magidor, and Shore [2], we see that CKDT is logically equivalent to the axioms of ATR0, the equivalence being provable in RCA0. (shrink)

By , we denote the system of second-order arithmetic based on recursive comprehension axioms and Σ10 induction. is defined to be plus weak König's lemma: every infinite tree of sequences of 0's and 1's has an infinite path. In this paper, we first show that for any countable model M of , there exists a countable model M′ of whose first-order part is the same as that of M, and whose second-order part consists of the M-recursive sets and sets not (...) in the second-order part of M. By combining this fact with a certain forcing argument over universal trees, we obtain the following result : if proves X!Y with arithmetical, so does . We also discuss several improvements of this results. (shrink)

In this paper, we introduce a system of nonstandard second-order arithmetic $\mathsf{ns}$-$\mathsf{WWKL_0}$ which consists of $\mathsf{ns}$-$\mathsf{BASIC}$ plus Loeb measure property. Then we show that $\mathsf{ns}$-$\mathsf{WWKL_0}$ is a conservative extension of $\mathsf{WWKL_0}$ and we do Reverse Mathematics for this system.

We examine the concept of almost everywhere domination from the viewpoint of mass problems. Let AED and MLR be the sets of reals which are almost everywhere dominating and Martin-Löf random, respectively. Let b1, b2, and b3 be the degrees of unsolvability of the mass problems associated with AED, MLR × AED, and MLR ∩ AED, respectively. Let [MATHEMATICAL SCRIPT CAPITAL P]w be the lattice of degrees of unsolvability of mass problems associated with nonempty Π01 subsets of 2ω. Let 1 (...) and 0 be the top and bottom elements of [MATHEMATICAL SCRIPT CAPITAL P]w. We show that inf, inf, and inf belong to [MATHEMATICAL SCRIPT CAPITAL P]w and 0 < inf < inf < inf < 1. Under the natural embedding of the recursively enumerable Turing degrees into [MATHEMATICAL SCRIPT CAPITAL P]w, we show that inf and inf but not inf are comparable with some recursively enumerable Turing degrees other than 0 and 0′. In order to make this paper more self-contained, we exposit the proofs of some recent theorems due to Hirschfeldt, Miller, Nies, and Stephan. (shrink)

Tube feeding is often presented as a nearly risk free and beneficial treatment for patients with dementia. But evidence shows that its benefits are illusory, while its risks are greater than many realize. Assisted oral feeding and good hospice care are better options.

Stephen Salkever shows that reading Aristotle is a starting point for discussing contemporary political problems in new ways that avoid the opposition between liberal individualism and republican communitarianism, between the politics of rights and the politics of virtues. Originally published in 1990. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in (...) durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Stephen Salkever shows that reading Aristotle is a starting point for discussing contemporary political problems in new ways that avoid the opposition between liberal individualism and republican communitarianism, between the politics of rights and the politics of virtues. Originally published in 1990. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in (...) durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

The thesis that scientists give greater weight to novel predictions than to explanations of known facts is tested against historical cases in physical science. Several theories were accepted after successful novel predictions but there is little evidence that extra credit was given for novelty. Other theories were rejected despite, or accepted without, making successful novel predictions. No examples were found of theories that were accepted primarily because of successful novel predictions and would not have been accepted if those facts had (...) been previously known. (shrink)

The authority of the intact self over the future severely demented self is based on notions of integrity and precedent autonomy. Despite criticism of this authority, the principle of precedent autonomy in the care of people with Alzheimer disease or other progressive and irreversible dementias retains its moral significance.

A well known fact is that every Lebesgue measurable set is regular, i.e., it includes an F$_{\sigma}$ set of the same measure. We analyze this fact from a metamathematical or foundational standpoint. We study a family of Muchnik degrees corresponding to measure-theoretic regularity at all levels of the effective Borel hierarchy. We prove some new results concerning Nies's notion of LR-reducibility. We build some $\omega$-models of RCA$_0$which are relevant for the reverse mathematics of measure-theoretic regularity.

This essay traces the interlinked origins of two concepts found in Charles Darwin's writings: "unconscious selection," and sexual selection as applied to humanity's anatomical race distinctions. Unconscious selection constituted a significant elaboration of Darwin's artificial selection analogy. As originally conceived in his theoretical notebooks, that analogy had focused exclusively on what Darwin later would call "methodical selection," the calculated production of desired changes in domestic breeds. By contrast, unconscious selection produced its results unintentionally and at a much slower pace. Inspiration (...) for this concept likely came from Darwin's early reading of works on both animal breeding and physical ethnology. Texts in these fields described the slow and unplanned divergence of anatomical types, whether animal or human, under the guidance of contrasting ideals of physical perfection. These readings, it is argued, also led Darwin to his theory of sexual selection as applied to race, a theme he discussed mainly in his book The Descent of Man. There Darwin described how the racial version of sexual selection operated on the same principle as unconscious selection. He thereby effectively reunited these kindred concepts. (shrink)