Online research in philosophy

Complementary and alternative medicines (CAM) have become increasingly popular over recent decades. Within bioethics CAM has so far mostly stimulated discussions around their level of scientific evidence, or along the standard concerns of bioethics. To gain an understanding as to why CAM is so successful and what the CAM success means for health care ethics, this paper explores empirical research studies on users of CAM and the reasons for their choice. It emerges that there is a close connection to fundamental principles of medical ethics. The studies also highlight that CAM’s holistic ontology of health and illness has an empowering effect on people in caring for their health, and on an even deeper level, safeguards against biomedicine’s reducing image of oneself as biological body-machine. The question is raised what lessons bioethics should draw from this emancipatory social movement for its own relationship with biomedicine.

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise.

In evidence-based medicine (EBM), methodology has become the central means of determining the quality of the evidence base. The “gold standard” method, the randomised, controlled trial (RCT), imbues medical research with an ethos of disinterestedness; yet, as this essay argues, the RCT is itself a rhetorically interested construct essential to medical-professional boundary work. Using the example of debates about methodology in EBM-oriented research on complementary and alternative medicine (CAM), practices not easily tested by RCTs, I frame the problem of method as a fundamentally rhetorical problem, situated within a boundary drama, and deeply rooted in the discursive practices of science and medicine. The genre of the RCT report, for example, idealises the research process and can tilt the course of arguments about CAM, while the notion of efficacy can function as a rhetorically mobile boundary object that can redefine the very terms of debate. I suggest herein that arguments about method in CAM debates can productively be read, metonymically, as expressions of more general anxieties in medicine about knowledge and evidence, community values, and professional boundaries; as such, these debates can illuminate some of the rhetorical dimensions of EBM.

A view among methodologists is that truth and convergence are related in such a way that scienti…c theories in their historical order of appearance contribute to the convergence to an ultimate ideal theory. It is not a fact that science develops accordingly but rather a hypothetical thought experiment to explain why science develops at all. Here, a simple formal model is presented for scrutinizing the relations between two truths and convergence.

Against the backdrop of the political intrigue in biomedicine’s ascendancy to orthodoxy, this article examines its contemporary rapprochement with Complementary Alternative Medicine (CAM), in the move toward an integrated medical regime. It also identifies and explores factors underlying the rapprochement, as well as different ethical challenges that face integrated medicine. It argues that a major approach to tackling these challenges hinges on devising just and equitable criteria for evaluating the efficacy of plural therapeutic paradigms inherent in CAM models. This is attainable through a policy that encourages creating public health policy and medical personnel deliberately exposed as part of their curriculum to the philosophical and theoretical features of diverse therapeutic traditions.

After historically situating NBIC Convergence in the context of earlier bioethical debate on genetics, ten questions are raised in areas related to the ethics of Convergence, indicating where future research is needed.

This chapter combines rhetorical with conceptual analysis to argue that the concept of convergence of technologies is a teleological concept that does not describe or predict any recent past, present, or future development. Instead it always expresses or attributes political goals of how future technology should be developed. The concept was already fully developed as a flexible rhetorical tool by US science administrators to create nanotechnology (as nano-convergence), before it was broadened to invent the convergence of nano-, bio-, info-, and cogno-research (NBIC-convergence). Analyzing the use of “convergence” in various US reports, such as in convergence did, does, can, will likely, will necessarily, should, and ought to happen, sheds new light on how science policy avoids public debates about goals and values in deliberating the future, which poses new challenges to STS.

The more popular complementary and alternative medicine (CAM) has become, the more often it is demanded that the integration of CAM should be limited to those approaches that are scientifically proven to be effective. This paper argues that this demand is ethically and philosophically questionable. The clinical legitimacy being gained by CAM and its increasing informal integration should instead caution against upholding the biomedical framework and evidence-based medicine as conditions of acceptance. Patients’ positive experiences with CAM deserve a truly scientific exploration of non-biomedical conceptualizations of health and illness. It is also problematic to request scientific evidence when there is proven resistance against CAM in research institutions, under-funding and a lack of suitable research methodologies. This is even more so, when much conventional medicine is not practiced with the same level of evidence as demanded from CAM.

Evolutionary convergence is often appealed to in support of claims about multiple realization. The idea is that convergence shows that the same function can be realized by different kinds of structures. I argue here that the nature of convergence is more complicated than it might appear at first look. Broad claims about convergence are made by biologists during general discussions of the mechanisms of evolution. In their specialized work, though, biologists are often more limited in the claims they make. I will examine a standard example to show how claims about convergence can be oversimplified.

The objectivity of Bayesian induction relies on the ability of evidence to produce a convergence to agreement among agents who initially disagree about the plausibilities of hypotheses. I will describe three sorts of Bayesian convergence. The first reduces the objectivity of inductions about simple "occurrent events" to the objectivity of posterior probabilities for theoretical hypotheses. The second reveals that evidence will generally induce converge to agreement among agents on the posterior probabilities of theories only if the convergence is 0 or 1. The third establishes conditions under which evidence will very probably compel posterior probabilities of theories to converge to 0 or 1.