It is sometimes thought that randomized study group allocation is uniquely proficient at producing comparison groups that are evenly balanced for all confounding causes. Philosophers have argued that in real randomized controlled trials this balance assumption typically fails. But is the balance assumption an important ideal? I run a thought experiment, the CONFOUND study, to answer this question. I then suggest a new account of causal inference in ideal and real comparative group studies that helps clarify the roles of confounding (...) variables and randomization. 1Confounders and Causes2The Balance Assumption3The CONFOUND Study 3.1CONFOUND 13.2CONFOUND 24Disjunction C and the Ideal Study 4.1The ultimate ‘other cause’: C4.2The ideal comparative group study4.3Required conditions for causal inference5Confounders as Causes, Confounders as Correlates6Summary. (shrink)

COVID-19 epidemic models raise important questions for science and philosophy of science. Here I provide a brief preliminary exploration of three: what kinds of predictions do epidemic models make, are they causal models, and how do different kinds of epidemic models differ in terms of what they represent?

Many epidemics consist in individuals spreading infection to others. From the population perspective, they also have population characteristics important in modeling, explaining, and intervening in epidemics. I analyze epidemiology’s contemporary population perspective through the example of epidemics by examining two central principles attributed to Geoffrey Rose: a distinction between the causes of cases and the causes of incidence, and between “high-risk” and “population” strategies of prevention. Both principles require revision or clarification to capture the sense in which they describe distinct (...) perspectives on the same phenomenon, each perspective capturing a different level of contrastive analysis. (shrink)

Simple extrapolation is the orthodox approach to extrapolating from clinical trials in evidence-based medicine: extrapolate the relative effect size from the trial unless there is a compelling reason not to do so. I argue that this method relies on a myth and a fallacy. The myth of simple extrapolation is the idea that the relative risk is a ‘golden ratio’ that is usually transportable due to some special mathematical or theoretical property. The fallacy of simple extrapolation is an unjustified argument (...) from ignorance: we conclude that the relative effect size is transportable in the absence of evidence to the contrary. In short, simple extrapolation is a deeply problematic solution to the problem of extrapolation. (shrink)

What kind of a thing are chronic diseases? Are they objects, bundles of signs and symptoms, properties, processes, or fictions? Rather than using concept analysis—the standard approach to disease in the philosophy of medicine—to answer this metaphysical question, I use a bottom-up, inductive approach. I argue that chronic diseases are bodily states or properties—often dispositional, but sometimes categorical. I also investigate the nature of related pathological entities: pathogenesis, etiology, and signs and symptoms. Finally, I defend my view against alternate accounts (...) of the nature of disease. (shrink)

Introduction: Clinical practice guidelines (CPGs) are an important source of justification for clinical decisions in modern evidence-based practice. Yet, we have given little attention to how they argue their evidence. In particular, how do CPGs argue for treatment with long-term medications that are increasingly prescribed to older patients? Approach and rationale: I selected six disease-specific guidelines recommending treatment with five of the medication classes most commonly prescribed for seniors in Ontario, Canada. I considered the stated aims of these CPGs and (...) the techniques employed towards those aims. Finally, I reconstructed and logically analysed the arguments supporting recommendations for pharmacotherapy. Analysis: The primary function of CPGs is rhetorical, or persuasive, and their means of persuasion include both a display of their credibility and their argumentation. Arguments supporting pharmacotherapy recommendations for the target population follow a common inductive pattern: statistical generalization from randomized controlled trial (RCT) and meta-analysis evidence. Two of the CPGs also argue their treatment recommendations for older patients in this style, while three fail to justify pharmacotherapy specifically for the older population. Discussion: The arguments analysed lack the auxiliary assumptions that would warrant making a generalization about the clinical effectiveness of medications for the older population. Guidelines reason using simple induction, while ignoring important inferential gaps. Future guidelines should aspire to be well-reasoned rather than simply evidence-based; argue from a plurality of evidence; be wary of hasty inductions; appropriately limit the scope of their recommendations; and avoid making law-like, prescriptive generalizations. (shrink)

With the ascent of modern epidemiology in the Twentieth Century came a new standard model of prediction in public health and clinical medicine. In this article, we describe the structure of the model. The standard model uses epidemiological measures-most commonly, risk measures-to predict outcomes (prognosis) and effect sizes (treatment) in a patient population that can then be transformed into probabilities for individual patients. In the first step, a risk measure in a study population is generalized or extrapolated to a target (...) population. In the second step, the risk measure is particularized or transformed to yield probabilistic information relevant to a patient from the target population. Hence, we call the approach the Risk Generalization-Particularization (Risk GP) Model. There are serious problems at both stages, especially with the extent to which the required assumptions will hold and the extent to which we have evidence for the assumptions. Given that there are other models of prediction that use different assumptions, we should not inflexibly commit ourselves to one standard model. Instead, model pluralism should be standard in medical prediction. (shrink)

Over the past several decades, we devoted much energy to generating, reviewing and summarizing evidence. We have given far less attention to the issue of how to thoughtfully apply the evidence once we have it. That’s fine if all we care about is that our clinical decisions are evidence-based, but not so good if we also want them to be well-reasoned. Let us not forget that evidence based medicine (EBM) grew out of an interest in making medicine ‘rational’, with the (...) idea that rational clinical evaluations should be evidence-based. I agree with the uncontroversial statement that the best decision is supported, at least in part, by the best available evidence. Rationality, however, is constituted by reasoning, not evidence. Complete arguments are necessary for rational evaluations, arguments that begin with general evidence and end in a conclusion about a particular patient. In order to traverse these inferential gaps, medicine must address the issue of how to establish, as an intermediate premise, what the evidence has to say about the efficacy of an intervention for particular patients in a particular practice setting. (shrink)

The new field of meta-research investigates industry bias, publication bias, contradictions between studies, and other trends in medical research. I argue that its findings should be used as meta-evidence for evaluating therapies. ‘Meta-evidence’ is evidence about the support that direct ‘first-order evidence’ provides the hypothesis. I consider three objections to my proposal: the irrelevance objection, the screening-off objection, and the underdetermination objection. I argue that meta-research evidence works by rationally revising our confidence in first-order evidence and, consequently, in the hypothesis—typically, (...) downward. (shrink)

What meaning does epidemiological evidence have for the individual? In evidence-based medicine, epidemiological evidence measures the patient’s risk of the outcome or the change in risk due to an intervention. The patient’s risk is commonly understood as an individual probability. The problem of understanding epidemiological evidence and risk thus becomes the challenge of interpreting individual patient probabilities. I argue that the patient’s risk is interpreted ontically, as a propensity. After exploring formidable problems with this interpretation in the medical context, I (...) propose an epistemic reinterpretation of individual patient probabilities as credences. On this view, epidemiological evidence informs medical uncertainty. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

In this article, I will reconstruct the monocausal model and argue that modern 'multifactorial diseases' are not monocausal by definition. 'Multifactorial diseases' are instead defined according to a constitutive disease model. On closer analysis, infectious diseases are also defined using the constitutive model rather than the monocausal model. As a result, our classification models alone cannot explain why infectious diseases have a universal etiology while chronic and noncommunicable diseases lack one. The explanation is instead provided by the nineteenth-century germ theorists.

Medical interventions that cure or prevent medical conditions are central to medicine; and thus, understanding them is central to our understanding of medicine. My purpose in this paper is to explore the conceptual foundations of medicine by providing a singular analysis of the concept of a ‘preventive or curative medical intervention’. Borrowing a general account of prevention from Phil Dowe, I provide an analysis of prevention, cure, risk reduction, and a preventive or curative intervention, before turning to preventive and curative (...) medical interventions. The resulting counterfactual-mechanistic account holds that preventive and curative medical interventions reduce the probability of a medical condition in an actual population compared to their counterfactual omission, commonly by disrupting an etiological or constitutive mechanism for the condition. (shrink)

In this paper I argue that a principal argument in favor of the existence of non-conceptual content (henceforth NCC) fails. That is, I do not accept that considerations regarding the richness of our perceptual experiences support the existence of NCC. I argue instead that the existence of NCC is empirically motivated. Here is an outline of the paper. First, I set out the distinction between conceptual content and NCC as we understand it. Second, I consider the richness argument (RA), and (...) argue that it fails. I argue in particular that RA (or RA-style arguments) are either self-defeating or confl ict with reasonably established accounts of early perceptual processing. Third, I tackle a residual phenomenological puzzle and offer a solution to it. Fourth, I argue that the existence of NCC enjoys empirical support. I argue in particular that states associated with early stages of visual perceptual processing have NCC. (shrink)

: The thirteenth-century Tibetan thinker Sakya Pandita was a diehard supporter of nominalism with respect to abstract entities. Here, two arguments given by Sakya Pandita against the robust existence of concepts (don spyi) are analyzed and elucidated. The first argument is rooted in the Buddhist idea that conceptual thought is unsound, whereas the second argument arises from considerations of intersubjectivity and verification. By presenting these arguments we gain both a fuller picture of the central role played by concepts within (...) the Tibetan tradition of philosophy of mind and a better appreciation of the philosophical acuity of the Tibetan polymath Sakya Pandita. (shrink)

This paper characterizes two senses in which Hegel interpretations can be (anti-)metaphysical. It argues that Pippin's seminal work misreads Hegel’s Being Logic through reading it anti-metaphysically, in one of these senses. But it also suggests that Pippin’s recent work makes room for a metaphysical (in the corresponding sense) reinterpretation of the Being Logic. So it pushes, in the spirit of a friendly amendment, for a fuller such reinterpretation, one that nevertheless coheres with Pippin’s deep commitments about Hegel as a (...) post-Kantian philosopher, since the reading remains, in the relevant sense—now the other one—anti-metaphysical. (shrink)

This is a pugnacious book, born of ancient controversy and attempting to return the debate to a time before the central jurisprudential questions were set by Hart and other legal positivists. Simmonds addresses those familiar with current analytical philosophy of law: those of us who know our Hart, Fuller, Dworkin, Raz, MacCormick and Kramer, and who perhaps need to have our attention drawn to Plato, Aristotle, Grotius, Hobbes and Kant. Presuming an informed readership, there is no bibliography, and it (...) incorporates ‘substantial extracts from four recent essays’ , but does not say what they are. Overall, his position is that law should be understood as an attempt to realize an archetype of law, an archetype which is a moral ideal. Those suspicious of moral ideals are not likely to find moral archetypes more philosophically acceptable. Yet, if Simmonds is right, we need them in jurisprudence.Simmonds is against the positivist split between …. (shrink)

A great deal is compressed into this passage; pleasure is associated in important ways with our nature; it has a crucial role in moral education; we can be pleased and displeased correctly or incorrectly, and this has a place in making character; and pleasure is something that matters all through a human life. Some of the themes are introduced and discussed at earlier places in the Ethics; some receive fuller treatment in book 10. The idea that some things are (...) naturally pleasant and that the virtuous find pleasure in the correct things first occurrs in book 1. The centrality of pleasure to Aristotle's ethical inquiry is perhaps not obvious right away, but it is unmistakable when the Ethics is considered as a whole. Its relation to good is fundamental. (shrink)

Partisan historiographic intervention has strongly shaped what we know of the life and writings of the controversial Northern Song dynasty official Wang Anshi. Thus, interpreting his surviving textual legacy presents a significant challenge. The two monographs under review offer very different approaches to this challenge. Yang Xiaoshan explores the history of the interpretive issues, while Jonathan Pease takes a very personal approach to a lifetime of reflection on Wang Anshi’s life and works.

This chapter begins with an empirical analysis of attitudes towards the law, which, in turn, inspires a philosophical re-examination of the moral status of the rule of law. In Section 2, we empirically analyse relevant survey data from the US. Although the survey, and the completion of our study, preceded the recent anti-police brutality protests sparked by the killing of George Floyd, the relevance of our observations extends to this recent development and its likely reverberations. Consistently with prior studies, we (...) find that people’s ascriptions of legitimacy to the legal system are predicted strongly by their perceptions of the procedural justice and lawfulness of police and court officials’ action. Two factors emerge as significant predictors of people’s compliance with the law: (i) their belief that they have a (content-independent, moral) duty to obey the law (which is one element of legitimacy, as defined here); and (ii) their moral assessment of the content of specific legal requirements (‘perceived moral content of laws’). We also observe an interactive relationship between these two factors. At higher levels of perceived moral content of laws, felt duty to obey is a better predictor of compliance. And, similarly, perceived moral content of laws is a better predictor of compliance at higher levels of felt duty to obey. This suggests that the moral content incorporated in specific laws interacts with the normative force people ascribe to legal authorities by virtue of other qualities, specifically here procedural justice and lawfulness. In Section 3, the focus shifts to a philosophical analysis, whereby we identify a parallel (similarly interactive) modality in the way that form and content mutually affect the value of the rule of law. We advocate a distinctive alternative to two rival approaches in jurisprudential discourse, the first of which claims that Lon Fuller’s eight precepts of legality embody moral qualities not contingent on the law’s content, while the second denies any independent moral value in these eight precepts, viewing them as entirely subservient to the law’s substantive goals. In contrast, on the view put forward here, Fuller’s principles possess (inter alia) an expressive moral quality, but their expressive effect does not materialise in isolation from other, contextual factors. In particular, the extent to which it materialises is partly sensitive to the moral quality of the law’s content. (shrink)

Theories of discourse bring to realism new ideas about how knowledge develops and how representations of reality are influenced. We gain an understanding of the conceptual aspect of social life and the processes by which meaning is produced. This collection reflects the growing interest realist critics have shown towards forms of discourse theory and deconstruction. The diverse range of contributions address such issues as the work of Derrida and deconstruction, discourse theory, Eurocentrism and poststructuralism. What unites all of the contributions (...) is a sense that it is essential to provide a realist alternative to the hitherto dominance of social constructionism, hermeneutics and postmodernism, over many of the issues discussed. By developing a realist perspective the different authors attempt to embed discourse within the structured nature of the reality of the world. Realism can situate language, discourse and ideology within context specific, or 'causally efficacious' circumstances. Realism can help to uncover issues of power, representation, and subjectivity and how discursive and other social practices produce real effects. This can help us understand the manner in which social structures are reproduced through various forms of ideology and discourse. And by knowing this, we can start to address questions concerning human emancipation and how the world is to be transformed. (shrink)

In the wake of the Scientific Revolution, the late seventeenth and eighteenth centuries saw the complete demolition of traditional structures of authority, scientific thought, and belief by the new philosophy and the philosophes, including Voltaire, Diderot, and Rousseau. The Radical Enlightenment played a part in this revolutionary process, which effectively overthrew all justification for monarchy, aristocracy, and ecclesiastical power, as well as man's dominance over woman, theological dominance of education, and slavery. Despite the present day interest in the revolutions of (...) the eighteenth century, the origins and rise of the Radical Enlightenment have received limited scholarly attention. The greatest obstacle to the movement finding its proper place in modern historical writing is its international scope: the Racial Enlightenment was not French, British, German, Italian, Jewish or Dutch, but all of these at the same time. In this wide-ranging volume, Jonathan Israel offers a novel interpretation of the Radical Enlightenment down to La Mettie and Diderot, two of its key exponents. Particular emphasis is placed on the pivotal role of Spinoza and the widespread underground international philosophical movement known before 1750 as Spinozism. (shrink)

The essays in this volume represent Lon Fuller's 'exercises in eunomics', a term for 'the study of good order and workable social arrangements.'.

Thomas Kuhn's _Structure of Scientific Revolutions_ has sold over a million copies in more than twenty languages and has remained one of the ten most cited academic works for the past half century. In contrast, Karl Popper's seminal book _The Logic of Scientific Discovery_ has lapsed into relative obscurity. Although the two men debated the nature of science only once, the legacy of this encounter has dominated intellectual and public discussions on the topic ever since. Almost universally recognized as the (...) modern watershed in the philosophy of science, Kuhn's relativistic vision of shifting paradigms -- which asserted that science was just another human activity, like art or philosophy, only more specialized -- triumphed over Popper's more positivistic belief in science's revolutionary potential to falsify society's dogmas. But has this victory been beneficial for science? Steve Fuller argues that not only has Kuhn's dominance had an adverse impact on the field but both thinkers have been radically misinterpreted in the process. This debate raises a vital question: Can science remain an independent, progressive force in society, or is it destined to continue as the technical wing of the military-industrial complex? Drawing on original research -- including the Kuhn archives at MIT -- Fuller offers a clear account of "Kuhn vs. Popper" and what it will mean for the future of scientific inquiry. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

This book provides a clear, concise description of medical law; but it does more than that. It also provides an introduction to the ethical principles that can be used to challenge or support the law. It also provides a range of perspectives from which to analyse the law: feminist, religious and sociological perspectives are all used.

Liberalism without Perfection offers an introduction to the debate between liberal perfectionism and political liberalism. This book is a new account and defence of Rawlsian political liberalism, one of the most discussed, but widely misunderstood and criticized theories in contemporary political theory.

In this major new book, the internationally renowned thinker Jonathan Bennett offers a deeper understanding of what is going on in our own moral thoughts about human behavior. The Act Itself presents a conceptual analysis of descriptions of behavior on which we base our moral judgements, and shows that this analysis can be used as a means toward getting more control of our thoughts and thus of our lives.

This title presents a comprehensive guide to interpretative phenomenological analysis (IPA) which is an increasingly popular approach to qualitative inquiry taught to undergraduate and postgraduate students today.

The fall of the Berlin Wall had enormous symbolic resonance, marking the collapse of Marxist politics and economics. Indeed, Marxist regimes have failed miserably, and with them, it seems, all reason to take the writings of Karl Marx seriously. Jonathan Wolff argues that if we detach Marx the critic of current society from Marx the prophet of some never-to-be-realized worker's paradise, he remains the most impressive critic we have of liberal, capitalist, bourgeois society. The author shows how Marx's main (...) ideas still shed light on wider concerns about culture and society and he guides the reader through Marx's notoriously difficult writings. Wolff also argues that the value of a great thinker does not depend on his or her views being true, but on other features such as originality, insight, and systematic vision. From this perspective, Marx still richly deserves to be read. Why Read Marx Today? reinstates Marx as an important critic of current society, and not just a figure of historical interest. (shrink)

" Here Jonathan Lear argues that irony is one of the tools we use to live seriously, to get the hang of becoming human.

Joan McGregor argues that “colleges and universities should adopt as part of their core mission the development of skills of civil discourse” rather than engaging in the practice of restricting controversial speakers from making presentations on campuses. I agree with McGregor concerning the need for increased civil discourse. However, this does not mean universities should welcome speakers to publicly present any material they wish without restriction or oversight. In this paper, I make three main arguments: (i) Colleges and universities have (...) a duty to protect members of the campus community from the harm and exclusion resulting from hateful or harmful speech, in the same way that they must protect them from sexual assaults and concussions. (ii) In the vast majority of cases, this duty can be fulfilled by holding speakers to standards of discourse that prevail in academic debate, and insisting on a number of procedural requirements. (iii) We should be wary of conservative arguments framed in terms of free speech, because they can be deployed to undermine important functions of the university in a democratic society, namely, to teach students how to be discerning citizens, and to protect thinkers willing to be critical of the government and the ruling classes. (shrink)

John Locke's Essay Concerning Human Understanding is among the most important books in philosophy ever written. It is a difficult work dealing with many themes, including the origin of ideas; the extent and limits of human knowledge; the philosophy of perception; and religion and morality. This volume focuses on the last two topics and provides a clear and insightful survey of these overlooked aspects of Locke's best-known work. Four eminent Locke scholars present authoritative discussions of Locke's view on the ethics (...) of belief, personal identity, free will and moral theory. (shrink)