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)

: 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)

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)

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)

How should one understand knowledge-wh ascriptions? That is, how should one understand claims such as ‘‘I know where the car is parked,’’ which feature an interrogative complement? The received view is that knowledge-wh reduces to knowledge that p, where p happens to be the answer to the question Q denoted by the wh-clause. I will argue that knowledge-wh includes the question—to know-wh is to know that p, as the answer to Q. I will then argue that knowledge-that includes a contextually (...) implicit question. I will conclude that knowledge is a question-relative state. Knowing is knowing the answer, and whether one knows the answer depends (in part) on the question. (shrink)

Discovering someone disagrees with you is a common occurrence. The question of epistemic significance of disagreement concerns how discovering that another disagrees with you affects the rationality of your beliefs on that topic. This book examines the answers that have been proposed to this question, and presents and defends its own answer.

Social thinkers in all fields are faced with one unavoidable question: what does it mean to be 'human' in the 21st century? As definitions between what is 'animal' and what is 'human' break down, and as emerging technologies such as artificial intelligence and nano- and bio- technologies develop, accepted notions of humanity are rapidly evolving. Humanity 2.0 is an ambitious and groundbreaking book, offering a sweeping overview of key historical, philosophical and theological moments that have shaped our understandings of humanity. (...) Tackling head on the twin taboos that have always hovered over the scientific study of humanity - race and religion - Steve Fuller argues thar far from disappearing, they are being reinvented. Fuller argues that these new developments will force us to decide which features of our current way of life - not least our bodies - are truly needed to remain human, and concludes with a consideration of these changes for ethical and social values more broadly. (shrink)

The Sociology of Intellectual Life outlines a social theory of knowledge for the 21st century. Steve Fuller deals directly with a world in which it is no longer taken for granted that universities and academics are the best places and people to embody the life of the mind. While Fuller defends academic privilege, he takes very seriously the historic divergences between academics and intellectuals, attending especially to the different features of knowledge production that they value."--BOOK JACKET.

Social thinkers in all fields are faced with one unavoidable question: What does it mean to be human in the 21st century? This ambitious and groundbreaking book provides the first synthesis of historical, philosophical and sociological insights needed to address this question in a thoughtful and creative manner.

In this study of events and their places in our language and thought, Bennett propounds and defends views about what kind of item an event is, how the language of events works, and about how these two themes are interrelated. He argues that most of the supposedly metaphysical literature is really about the semantics of their names, and that the true metaphysic of events--known by Leibniz and rediscovered by Kim--has not been universally accepted because it has been tarred with the (...) brush of a false semantic theory. (shrink)

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

Ichikawa and Jarvis offer a new rationalist theory of mental content and defend a traditional epistemology of philosophy. They argue that philosophical inquiry is continuous with non-philosophical inquiry, and can be genuinely a priori, and that intuitions do not play an important role in mental content or the a priori.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:WisCon 46Laurie Fuller, Jenna N. Hanchey, and E. OrnelasExistence as Resistance, WisCon 46, May 26–29, 2023, Madison, Wisconsin, United StatesIn a world that seems structured to kill most of its occupants, there is a utopian impulse in the act of existence itself. WisCon 46 represented a prefigurative utopian impulse through centering continued marginalized existence as resistance.1 Leah Lakshmi Piepzna-Samarasinha calls “prefigurative politics” the “fancy term for the (...) idea of imagining and building the world we want to see now,” particularly in terms of access needs.2 The structure as well as the content of the convention itself created a space in which to set the groundwork for utopia: the ways that we live and act to resist structures of oppression in order to prefigure a better world.Since WisCon’s founding in 1977, its intended audience has been fans, authors, and academics interested in the intersection between feminism and “science fiction, fantasy, and speculative literature of all sorts.”3 While neither feminism nor speculative fiction could be solely defined as utopian, both do explore utopian impulses that inspire change for the better. Therein lies the hope of Alessa Johns’s proposal that “the utopian imagination has been crucial for feminists.”4 Lisa Yaszek agrees: “for nearly 200 years writers have used speculative fiction consciously and collectively to dramatize the political issues most central to women living in a technocultural world and to create a sense of wonder about the interrelated possibilities of social and scientific change.”5 Envisioning a liberatory world is a feminist imperative, and speculative fiction offers a unique venue to do so. This imperative informed WisCon this year, as participants collectively worked to imagine and enact a better future for marginalized folks, in and beyond the space of the conference. [End Page 618]Enabling Existence through Con StructuresWisCon is unique in attuning its organizational structure to the creation of liberatory futures in the here and now. WisCon is strongly attentive to disability access of all kinds, COVID safety, antiracist/anti-oppression principles, and safety and anti-abuse support for all these areas. In the contemporary US context—where COVID-19 remains a major barrier to disabled people wishing to participate in conventions, where racist violence continues to threaten BIPOC (Black, Indigenous, and People of Color) life, where queer and trans folks are under exacerbated legal attacks—creating a convention space that protects and enables marginalized participation becomes a means of prefiguring utopian potential through embodied praxis. As mask, capacity, and vaccination mandates disappear (despite these ongoing pandemic times), and as bigotry of all forms continues relatively unabated, WisCon 46 remains steadfast in its commitment to safety. In short, the conference itself aims to become a utopian space.WisCon organizers are also keenly aware of the challenges that many different bodyminds might encounter in large group settings.6 Trained monitors oversee in-person and online programming in an effort to discourage harmful words and actions as well as ensure the fullest participation for those most impacted. Hence, disability justice lies at the center of the Con’s policies and practices. The event is made as accessible as possible through careful attention to venue selection, including the availability of gender-neutral bathrooms, scent-free spaces, and quiet rooms, as well as the use of color communication badges.This year’s event followed strict masking and testing protocols: individually packaged rapid COVID-19 tests were available without cost at registration, as were KN95 masks. The Con kept an anonymized record of self-reported positive COVID-19 tests, in case of possible exposure. This mutual responsibility reflects the kind of utopianism inherent to disability politics; that is, disability “allows for reformulation of in/dependence and community,” a way of rethinking how we share space and produce knowledge together.7The conference’s decidedly feminist approach “to creating a space for feminism and its consideration within the science fiction community” is applied at every level. The Con’s general organization and procedures are structured as nonhierarchically as possible. There is a board of directors as well as co-chairs, but these are rotating positions. This “commitment to feminism” is [End Page 619] reflected... (shrink)

Conditional sentences are among the most intriguing and puzzling features of language, and analysis of their meaning and function has important implications for, and uses in, many areas of philosophy. Jonathan Bennett, one of the world's leading experts, distils many years' work and teaching into this Philosophical Guide to Conditionals, the fullest and most authoritative treatment of the subject. An ideal introduction for undergraduates with a philosophical grounding, it also offers a rich source of illumination and stimulation for graduate (...) students and professional philosophers. (shrink)

All sorts of things may be described as 'inspired': a mathematical theorem, a work of art, a goal at football, a short-cut home from the shops. What lies behind all these? Where does 'inspiration' come from? Does it derive from a source external to the person inspired, or is it the end result of sheer hard work - or is it purely serendipitous? Within the fields of science and religion, the word 'inspiration' might be thought to carry very different connotations. (...) But is there a degree of overlap? If scientists and religious thinkers alike may acknowledge the power of inspiration, do we have here an important area of convergence between two important areas of human discourse which are all too often believed to be opposed to one another? These were some of the issues considered at the 2011 conference of the Science and Religion Forum, held at Cumberland Lodge near Windsor. This book presents papers from that conference, including contributions from such major thinkers as Lord Winston, Linda Woodhead and John Hedley Brooke, among other leading scientific and theological practitioners. Their wide-ranging studies - and very diverse conclusions - will be of interest to a wide readership. (shrink)

Conciliationism is the family of views that rationality requires agents to reduce confidence or suspend belief in p when acknowledged epistemic peers (i.e. agents who are (approximately) equally well-informed and intellectually capable) disagree about p. While Conciliationism is prima facie plausible, some have argued that Conciliationism is not an adequate theory of peer disagreement because it is self-undermining. Responses to this challenge can be put into two mutually exclusive and exhaustive groups: the Solution Responses which deny Conciliationism is self-undermining and (...) attempt to provide arguments which demonstrate this; and the Skeptical Responses which accept that Conciliationism is self-undermining but attempt to mitigate this result by arguing this is either impermanent and/or not very worrisome. I argue that, by Conciliationism’s own lights, both kinds of responses (almost certainly) fail to save Conciliationism from being self-undermining. Thus, Conciliationism is (almost certainly) permanently self-undermining. This result is significant because it demonstrates that Conciliationism is likely hopeless: there is likely nothing that can save Conciliationism from this challenge. I further argue that Conciliationism, like any view, should be abandoned if it is (almost certainly) hopeless. (shrink)

Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consultation. The authors discuss the role of clinical ethicists (...) in medical education and policy development. Finally, they conclude with some remarks on the distinctive contributions made by those with philosophical training to these endeavors and the importance of continued engagement by philosophers in this important public work. (shrink)