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The Philosophy of Evidence-Based Medicine

Wiley-Blackwell, Bmj Books (2011)

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  1. Treatment Effectiveness and the Russo–Williamson Thesis, EBM+, and Bradford Hill's Viewpoints.Steven Tresker - 2022 - International Studies in the Philosophy of Science 34 (3):131-158.
    Establishing the effectiveness of medical treatments is one of the most important aspects of medical practice. Bradford Hill's viewpoints play an important role in inferring causality in medicine,...
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  • ‘One Mission Accomplished, More Important Ones Remain ’: Commentary on Every-Palmer, S., Howick, J. (2014) How Evidence-Based Medicine is Failing Due to Biased Trials and Selective Publication. J Ournal of E Valuation in C Linical P Ractice, 20 (6), 908-914. [REVIEW]Peter Wyer & Suzana Alves da Silva - 2015 - Journal of Evaluation in Clinical Practice 21 (3):518-528.
  • Using Practical Wisdom to Facilitate Ethical Decision-Making: A Major Empirical Study of Phronesis in the Decision Narratives of Doctors.Chris Turner, Alan Brockie, Catherine Weir, Catherine Hale, Aisha Y. Malik & Mervyn Conroy - 2021 - BMC Medical Ethics 22 (1):1-13.
    BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any given case (...)
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  • Wherein is the Concept of Disease Normative? From Weak Normativity to Value-Conscious Naturalism.M. Cristina Amoretti & Elisabetta Lalumera - 2021 - Medicine, Health Care and Philosophy 25 (1):1-14.
    In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...)
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  • Mechanisms in Clinical Practice: Use and Justification.Mark R. Tonelli & Jon Williamson - 2020 - Medicine, Health Care and Philosophy 23 (1):115-124.
    While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. (...)
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  • What’s in a Gold Standard? In Defence of Randomised Controlled Trials.Marius Backmann - 2017 - Medicine, Health Care and Philosophy 20 (4):513-523.
    The standardised randomised clinical trial has been exceedingly popular in medical research, economics, and practical policy making. Recently, RCTs have faced criticism. First, it has been argued by John Worrall that we cannot be certain that our sample is not atypical with regard to possible confounding factors. I will argue that at least in the case of medical research, we know enough about the relevant causal mechanisms to be justified to ignore a number of factors we have good reason not (...)
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  • On the Epistemic Legitimacy of Government Paternalism.Johan Brännmark - 2018 - Public Health Ethics 11 (1):27-34.
    Some contemporary paternalists argue in favor of government interventions based on how experimental psychologists and behavioral economists have found that our behavior often diverges from what would be predicted by rational-choice models. In this article it is argued that these findings can, more specifically, be used to identify decisional trouble spots where paternalist interventions may be legitimate. It is further argued that since the epistemic legitimacy of government paternalism ultimately rests on centralized decision-making having a comparative advantage, it also depends (...)
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  • In Defence of an Inferential Account of Extrapolation.Tudor M. Baetu - 2021 - International Studies in the Philosophy of Science 34 (2):81-100.
    According to the hypothesis-generator account, valid extrapolations from a source to a target system are circular, since they rely on knowledge of relevant similarities and differences that can onl...
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  • Cancer.Anya Plutynski - 2019 - Stanford Encyclopedia of Philosophy.
    Cancer—and scientific research on cancer—raises a variety of compelling philosophical questions. This entry will focus on four topics, which philosophers of science have begun to explore and debate. First, scientific classifications of cancer have as yet failed to yield a unified taxonomy. There is a diversity of classificatory schemes for cancer, and while some are hierarchical, others appear to be “cross-cutting,” or non-nested. This literature thus raises a variety of questions about the nature of the disease and disease classification. Second, (...)
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  • Philosophy of Population Health: Philosophy for a New Public Health Era.Sean A. Valles - 2018 - Abingdon OX14, UK: Routledge.
    Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more than good hospitals and public (...)
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  • Philosophical Issues in Medical Intervention Research.Jesper Jerkert - 2015 - Dissertation, Royal Institute of Technology, Stockholm
    The thesis consists of an introduction and two papers. In the introduction a brief historical survey of empirical investigations into the effectiveness of medicinal interventions is given. Also, the main ideas of the EBM movement are presented. Both included papers can be viewed as investigations into the reasonableness of EBM and its hierarchies of evidence. Paper I: Typically, in a clinical trial patients with specified symptoms are given either of two or more predetermined treatments. Health endpoints in these groups are (...)
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  • Concepts and Causes in the Philosophy of Disease.Benjamin T. H. Smart - 2016 - London: Palgrave Macmillan UK.
    Disease is everywhere. Everyone experiences disease, everyone knows somebody who is, or has been diseased, and disease-related stories hit the headlines on a regular basis. Many important issues in the philosophy of disease, however, have received remarkably little attention from philosophical thinkers. -/- This book examines a number of important debates in the philosophy of medicine, including 'what is disease?', and the roles and viability of concepts of causation, in clinical medicine and epidemiology. Where much of the existing literature targets (...)
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  • Assigning Functions to Medical Technologies.Alexander Mebius - 2017 - Philosophy and Technology 30 (3):321-338.
    Modern health care relies extensively on the use of technologies for assessing and treating patients, so it is important to be certain that health care technologies perform their professed functions in an effective and safe manner. Philosophers of technology have developed methods to assign and evaluate the functions of technological products, the major elements of which are described in the ICE theory. This paper questions whether the standard of evidence advocated by the ICE theory is adequate for ascribing and assessing (...)
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  • Philosophical Controversies in the Evaluation of Medical Treatments : With a Focus on the Evidential Roles of Randomization and Mechanisms in Evidence-Based Medicine.Alexander Mebius - 2015 - Dissertation, KTH Royal Institute of Technology
    This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged (...)
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  • Negative Mechanistic Reasoning in Medical Intervention Assessment.Jesper Jerkert - 2015 - Theoretical Medicine and Bioethics 36 (6):425-437.
    Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM literature, although some recent authors have argued for an upgrade. Even so, the mechanistic reasoning that has received attention has almost exclusively been positive—both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types (...)
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  • Corroborating Evidence‐Based Medicine.Alexander Mebius - 2014 - Journal of Evaluation in Clinical Practice 20 (6):915-920.
    Proponents of evidence-based medicine have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence (...)
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  • On the Meaning of Medical Evidence Hierarchies.Jesper Jerkert - 2021 - Philosophy of Medicine 2 (1).
    Evidence hierarchies are lists of investigative strategies ordered with regard to the claimed strength of evidence. They have been used for a couple of decades within EBM, particularly for the assessment of evidence for treatment recommendations, but they remain controversial. An under-investigated question, from critics and adherents of evidence hierarchies alike, is what the order in the hierarchy means. Four interpretations of the order are distinguished and discussed. The two most credible ones are, roughly expressed, "typically stronger" or "ideally stronger". (...)
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  • Blinding and the Non-Interference Assumption in Medical and Social Trials.David Teira - 2013 - Philosophy of the Social Sciences 43 (3):358-372.
    This paper discusses the so-called non-interference assumption (NIA) grounding causal inference in trials in both medicine and the social sciences. It states that for each participant in the experiment, the value of the potential outcome depends only upon whether she or he gets the treatment. Drawing on methodological discussion in clinical trials and laboratory experiments in economics, I defend the necessity of partial forms of blinding as a warrant of the NIA, to control the participants’ expectations and their strategic interactions (...)
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  • Experiential Knowledge in Clinical Medicine: Use and Justification.Mark R. Tonelli & Devora Shapiro - 2020 - Theoretical Medicine and Bioethics 41 (2):67-82.
    Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...)
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  • Learning From Scientific Disagreement.Bruno Borge & Nicolás Lo Guercio - 2021 - Theoria: Revista de Teoría, Historia y Fundamentos de la Ciencia 36 (3):375-398.
    The article addresses the question of how should scientific peers revise their beliefs upon recognized disagreement. After presenting the basics of peer disagreement in sections 1 and 2, we focus, in section 3, on a concrete case of scientific disagreement, to wit, the dispute over the evidential status of randomized control trials in medical practice. The examination of this case motivates the idea that some scientific disagreements permit a steadfast reaction. In section 4, we support this conclusion by providing a (...)
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  • Values-Based Practice and Phenomenological Psychopathology: Implications of Existential Changes in Depression.Anthony Vincent Fernandez & Sarah Wieten - 2015 - Journal of Evaluation in Clinical Practice 21 (3):508-513.
    Values-based practice (VBP), developed as a partner theory to evidence-based medicine (EBM), takes into explicit consideration patients’ and clinicians’ values, preferences, concerns and expectations during the clinical encounter in order to make decisions about proper interventions. VBP takes seriously the importance of life narratives, as well as how such narratives fundamentally shape patients’ and clinicians’ values. It also helps to explain difficulties in the clinical encounter as conflicts of values. While we believe that VBP adds an important dimension to the (...)
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  • The Commercialization of Research and the Quest for the Objectivity of Science.S. Jukola - 2016 - Foundations of Science 21 (1):89-103.
    In this paper, I discuss the objectivity of science in the context of commercialized research. Objectivity has traditionally been associated with the behavior of individual scientists and their willingness and ability to base their reasoning on data and logic. By introducing some examples of problematic practices in current research, I show that this view is insufficient. A view that I call the Social View on objectivity succeeds better in accommodating the way in which commercialization affects research.
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  • Models in the Balance: Evidence‐Based Medicine Versus Evidence‐Informed Individualized Care.Andrew Miles & Michael Loughlin - 2011 - Journal of Evaluation in Clinical Practice 17 (4):531-536.
  • Stats.Con.Jeremy Howick - 2011 - Journal of Evaluation in Clinical Practice 17 (5):1011-1012.
  • Compellingness: Assessing the Practical Relevance of Clinical Research Results.Mark R. Tonelli - 2012 - Journal of Evaluation in Clinical Practice 18 (5):962-967.
  • Values‐Based Practice: Fulford's Dangerous Idea.Kenneth W. M. Fulford - 2013 - Journal of Evaluation in Clinical Practice 19 (3):537-546.
  • Mechanistic Understanding in Clinical Practice: Complementing Evidence‐Based Medicine with Personalized Medicine.Cecilia Nardini, Marco Annoni & Giuseppe Schiavone - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1000-1005.
  • Deciding on Suitability for Treatment.Harry Lesser - 2013 - Journal of Evaluation in Clinical Practice 19 (3):442-446.
  • Explanation, Understanding, Objectivity and Experience.Michael Loughlin, Robyn Bluhm, Drozdstoj S. Stoyanov, Stephen Buetow, Ross E. G. Upshur, Kirstin Borgerson, Maya J. Goldenberg & Elselijn Kingma - 2013 - Journal of Evaluation in Clinical Practice 19 (3):415-421.
  • Until RCT Proven? On the Asymmetry of Evidence Requirements for Risk Assessment.Barbara Osimani - 2013 - Journal of Evaluation in Clinical Practice 19 (3):454-462.
    The problem of collecting, analyzing and evaluating evidence on adverse drug reactions (ADRs) is an example of the more general class of epistemological problems related to scientific inference and prediction, as well as a central problem of the health-care practice. Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special (...)
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  • Mechanisms: What Are They Evidence for in Evidence-Based Medicine?Holly Andersen - 2012 - Journal of Evaluation in Clinical Practice 18 (5):992-999.
    Even though the evidence‐based medicine movement (EBM) labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. (...)
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  • Physiological Mechanisms and Epidemiological Research.Robyn Bluhm - 2013 - Journal of Evaluation in Clinical Practice 19 (3):422 - 426.
  • Virtue, Progress and Practice.Michael Loughlin, Robyn Bluhm, Stephen Buetow, Ross E. G. Upshur, Maya J. Goldenberg, Kirstin Borgerson & Vikki Entwistle - 2011 - Journal of Evaluation in Clinical Practice 17 (5):839-846.
  • The Application of Evidence-Based Medicine Methodologies in Sports Science: Problems and Solutions.William Levack-Payne - 2022 - Dissertation, University of Kent
    This thesis analyses the use of 'Evidence-Based' methodologies of evidence assessment and intervention and policy design from medicine, and their use in sport and exercise science. It argues that problems exist with the application of Evidence-Based methodologies in sports science, meaning that the quality of evidence used to inform decision-making is lower than is often assumed. This thesis also offers realistic solutions to these problems, broadly arguing for the importance of taking evidence from mechanistic studies seriously, in addition to evidence (...)
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  • Demarcating and Judging Medicine: Review of Broadbent’s Philosophy of Medicine. [REVIEW]Jonathan Fuller - 2021 - Philosophy of Science 88 (2):370-376.
  • Just How Wide Should ‘Wide Reading’ Be?Martin Lipscomb - 2015 - Nursing Philosophy 16 (4):187-202.
    Educationalists introduce students to literature search strategies that,with rare exceptions, focus chiefly on the location of primary research reports and systematic reviews of those reports. These sources are, however, unlikely to adequately address the normative and/or metaphysical questions that nurses frequently and legitimately interest themselves in. To meet these interests, non-research texts exploring normative and/or metaphysical topics might and perhaps should, in some situations, be deemed suitable search targets. This seems plausible and, moreover, students are encouraged to ‘read widely’. Yet (...)
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  • E-Synthesis: A Bayesian Framework for Causal Assessment in Pharmacosurveillance.Francesco De Pretis, Jürgen Landes & Barbara Osimani - 2019 - Frontiers in Pharmacology 10.
    Background: Evidence suggesting adverse drug reactions often emerges unsystematically and unpredictably in form of anecdotal reports, case series and survey data. Safety trials and observational studies also provide crucial information regarding the safety of drugs. Hence, integrating multiple types of pharmacovigilance evidence is key to minimising the risks of harm. Methods: In previous work, we began the development of a Bayesian framework for aggregating multiple types of evidence to assess the probability of a putative causal link between drugs and side (...)
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  • Problematic Placebos in Physical Therapy Trials.Matthew Maddocks, Roger Kerry, Andrew Turner & Jeremy Howick - 2016 - Journal of Evaluation in Clinical Practice 22 (4):598-602.
    The function of a placebo control in a randomised trial is to permit blinding and reduce risk of bias. Adopting Grűnbaum’s definitional scheme of a placebo, all treatments must be viewed as packages consisting of characteristic and incidental features. An adequate placebo for an experimental treatment contains none of the characteristic features, all of the incidental features, and nothing more. For drug treatments, characteristic features can be readily identified, isolated, and separated. By contrast, physical therapy treatments often involve features such (...)
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  • Philosophy of Epidemiology by A. Broadbent. Palgrave Macmillan, Basingstoke, 2013, £55.00, 228 Pp. ISBN 978 0 230 20210 8. [REVIEW]Jonathan Fuller - 2014 - Journal of Evaluation in Clinical Practice 20 (6):1002-1004.
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  • Book Review. Philosophy of Epidemiology by A. Broadbent. [REVIEW]Jonathan Fuller - 2014 - Journal of Evaluation in Clinical Practice 20 (6):1002-1004.
  • Is Evidence-Based Psychiatry Ethical? By Mona Gupta. Oxford University Press, Oxford, 2014, $52.95, 224 Pp. ISBN 978 0 199 64111 6. [REVIEW]Sarah E. Wieten - 2015 - Journal of Evaluation in Clinical Practice 21 (3):538-541.
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  • Has Evidence-Based Medicine Ever Been Modern? A Latour-Inspired Understanding of a Changing EBM.Sietse Wieringa, Eivind Engebretsen, Kristin Heggen & Trish Greenhalgh - 2017 - Journal of Evaluation in Clinical Practice 23 (5):964-970.
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  • ‘All the King's Horses …’: The Problematical Fate of Born-Again Evidence-Based Medicine: Commentary on Greenhalgh, T., Snow, R., Ryan, S., Rees, S., and Salisbury, H. (2015) Six ‘Biases’ Against Patients and Carers in Evidence-Based Medicine. BioMed Centr. [REVIEW]Peter Wyer & Suzana Alves da Silva - 2015 - Journal of Evaluation in Clinical Practice 21 (6):E1-E10.
  • Underdetermination in Evidence-Based Medicine.Benjamin H. Chin-Yee - 2014 - Journal of Evaluation in Clinical Practice 20 (6):921-927.
  • How Evidence‐Based Medicine is Failing Due to Biased Trials and Selective Publication.Susanna Every-Palmer & Jeremy Howick - 2014 - Journal of Evaluation in Clinical Practice 20 (6):908-914.
  • Causation and Evidence-Based Practive - an Ontological Review.Roger Kerry, Thor Eirik Eriksen, Svein Anders Noer Lie, Stephen D. Mumford & Rani Lill Anjum - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1006-1012.
    We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...)
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  • Research Problems and Methods in the Philosophy of Medicine.Michael Loughlin, Robyn Bluhm & Mona Gupta - 2017 - In .
    Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...)
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  • Epistemological and Ethical Aspects of Time in Scientific Research.Daria Jadreškić - 2020 - Dissertation, Leibniz University Hannover
    This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...)
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  • How Interventionist Accounts of Causation Work in Experimental Practice and Why There is No Need to Worry About Supervenience.Tudor M. Baetu - 2021 - Synthese 199 (1-2):4601-4620.
    It has been argued that supervenience generates unavoidable confounding problems for interventionist accounts of causation, to the point that we must choose between interventionism and supervenience. According to one solution, the dilemma can be defused by excluding non-causal determinants of an outcome as potential confounders. I argue that this solution undermines the methodological validity of causal tests. Moreover, we don’t have to choose between interventionism and supervenience in the first place. Some confounding problems are effectively circumvented by experimental designs routinely (...)
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  • Philosophers on Drugs.Bennett Holman - 2019 - Synthese 196 (11):4363-4390.
    There are some philosophical questions that can be answered without attention to the social context in which evidence is produced and distributed.ing away from social context is an excellent way to ignore messy details and lay bare the underlying structure of the limits of inference. Idealization is entirely appropriate when one is essentially asking: In the best of all possible worlds, what am I entitled to infer? Yet, philosophers’ concerns often go beyond this domain. As an example I examine the (...)
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