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.

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)

_ 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)

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)

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)

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)

A selective history of the benzene problem is presented, starting with August Kekulé's proposal of a hexagonal structure in 1865 and his hypothesis of 1872 that the carbon–carbon bonds oscillate between single and double. Only those theories are included that were accepted or at least discussed by a significant number of chemists. Special attention is given to predictions, their empirical tests, and the effect of the outcomes of those tests on the reception of the theories. At the end of the (...) period covered by this article, chemists generally accepted the valence bond theory proposed by Linus Pauling; some of them considered this a more sophisticated version of Kekulé's oscillation hypothesis. The sequel describes the replacement of the valence bond theory by the molecular orbital theory in the period ending around 1980. (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)

In the first part of the 19th century, geologists explained volcanoes, earthquakes and mountain-formation on the assumption that the earth has a large molten core underneath a very thin solid crust. This assumption was attacked on astronomical grounds by William Hopkins, who argued that the crust must be at least 800 miles thick, and on physical grounds by William Thomson, who showed that the earth as a whole behaves like a solid with high rigidity. Other participants in the debate insisted (...) that there is evidence for a fluid or plastic layer not far below the crust. It was also suggested that the interior of the earth is a supercritical fluid. By the end of the century many geologists had incorporated the doctrine of a completely solid earth into their theories. Acceptance of a relatively small liquid core, indicated by seismological research, was delayed for another two decades. (shrink)

In the second chapter of The descent of man , Charles Darwin interrupted his discussion of the evolutionary origins of language to describe ten ways in which the formation of languages and of biological species were ‘curiously’ similar. I argue that these comparisons served mainly as analogies in which linguistic processes stood for aspects of biological evolution. Darwin used these analogies to recapitulate themes from On the origin of species , including common descent, genealogical classification, the struggle for existence, and (...) natural selection, among others. Skeptical of this interpretation, Gregory Radick sees the naturalistic account of language formation in the Descent comparisons as reinforcing Darwin’s idea that languages and the races of mankind have both undergone progressive development. Yet the details of Darwin’s language–species comparisons, as well as the polemical context in which they appear, show that they were not aimed at so limited a function. Rather, they addressed issues related to species transmutation in general. (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)

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

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)

Summary In The Origin of Species, Charles Darwin famously accounted for the lack of fossil evidence in support of species evolution on the grounds that the fossil record is naturally incomplete. This essay examines a similar argument that Darwin applied to his analogy between natural and artificial selection: the scarcity of data about the historical backgrounds of domestic breeds was the natural by-product of an extremely gradual change process. The point was to enhance the ability of the artificial selection analogy (...) to suggest that nature's species had undergone a similar transformation. Darwin did not depend on this negative inference alone, however, for in his writings he included whatever information he could find about the actual histories of particular breeds. A comparison with Darwin's treatment of the fossil record suggests the reasonableness of this combined use of opposite kinds of evidence to establish a single point. The comparison also suggests the unique qualities of negative inference as applied to the breeding analogy. (shrink)

This paper examines Charles Darwin’s idea that language-use and humanity’s unique cognitive abilities reinforced each other’s evolutionary emergence—an idea Darwin sketched in his early notebooks, set forth in his Descent of man , and qualified in Descent’s second edition. Darwin understood this coevolution process in essentially Lockean terms, based on John Locke’s hints about the way language shapes thinking itself. Ironically, the linguist Friedrich Max Müller attacked Darwin’s human descent theory by invoking a similar thesis, the German romantic notion of (...) an identity between language and thought. Although Darwin avoided outright contradiction, when he came to defend himself against Müller’s attacks, he undercut some of his own argumentation in favor of the coevolution idea. That is, he found it difficult to counter Müller’s argument while also making a case for coevolution. Darwin’s efforts in this area were further complicated by British and American writers who held a naturalistic view of speech origins yet still taught that language had been invented by fully evolved homo sapiens, thus denying coevolution. (shrink)

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)

This paper examines the way Charles Darwin applied his domestic breeding analogy to the practical workings of species evolution: that application, it is argued, centered on Darwin's distinction between methodical and unconscious selection. Methodical selection, which entailed pairing particular individuals for mating purposes, represented conditions of strict geographic isolation, obviously useful for species multiplication (speciation). By contrast, unconscious selection represented an open landmass with a large breeding population. Yet Darwin held that this latter scenario, which often would include multiple ecological (...) subdistricts and thus partial isolation, was better suited for speciation than were isolated conditions. At the same time, many passages in Darwin's writings that apparently portrayed phyletic evolution exclusively (these including references to unconscious selection), actually applied to speciation as well, for phyletic change in a single district could constitute a local manifestation of a larger common-descent pattern. This generic use of "phyletic" change was reflected in Darwin's deployment of the unconscious selection analogy in his published writings as well as in his dispute with Moritz Wagner over the necessity of geographic isolation for speciation. We can thus understand Darwin's otherwise puzzling declaration in The Origin of Species that unconscious selection was 'more important' than the methodical approach. (shrink)

Higher order unification is a way of combining information (or equivalently, solving equations) expressed as terms of a typed higher order logic. A suitably restricted form of the notion has been used as a simple and perspicuous basis for the resolution of the meaning of elliptical expressions and for the interpretation of some non-compositional types of comparative construction also involving ellipsis. This paper explores another area of application for this concept in the interpretation of sentences containing intonationally marked focus, or (...) various semantic constructs which are sensitive to focus.Similarities and differences between this approach, and theories using alternative semantics, structured meanings, or flexible categorial grammars, are described. The paper argues that the higher order unification approach offers descriptive advantages over these alternatives, as well as the practical advantage of being capable of fairly direct computational implementation. (shrink)