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The Philosophy of Evidence-Based Medicine

Wiley-Blackwell, Bmj Books (2011)

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  1. ‘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.
  • 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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  • Mechanistic reasoning and the problem of masking.Michael Edward Wilde - 2021 - Synthese:1-16.
    At least historically, it was common for medical practitioners to believe causal hypotheses on the basis of standalone mechanistic reasoning. However, it is now widely acknowledged that standalone mechanistic reasoning is insufficient for appropriately believing a causal hypothesis in medicine, thanks in part to the so-called problem of masking. But standalone mechanistic reasoning is not the only type of mechanistic reasoning. When exactly then is it appropriate to believe a causal hypothesis on the basis of mechanistic reasoning? In this paper, (...)
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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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  • 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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  • Meaning and Affect in the Placebo Effect.Daniele Chiffi, Ahti-Veikko Pietarinen & Alessandro Grecucci - 2021 - Journal of Medicine and Philosophy 46 (3):313-329.
    This article presents and defends an integrated view of the placebo effect, termed “affective-meaning-making” model, which draws from theoretical reflection, clinical outcomes, and neurophysiological findings. We consider the theoretical limitations of those proposals associated with the “meaning view” on the placebo effect which leave the general aspects of meaning unspecified, fail to analyze fully the role of emotions and affect, and establish no clear connection between the theoretical, physiological, and psychological aspects of the effect. We point out that a promising (...)
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  • 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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  • 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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  • 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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  • ‘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.
  • 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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  • 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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  • Book Review. Philosophy of Epidemiology by A. Broadbent. [REVIEW]Jonathan Fuller - 2014 - Journal of Evaluation in Clinical Practice 20 (6):1002-1004.
  • 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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  • 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.
  • 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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  • 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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  • Physiological Mechanisms and Epidemiological Research.Robyn Bluhm - 2013 - Journal of Evaluation in Clinical Practice 19 (3):422 - 426.
  • 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.
  • Values‐Based Practice: Fulford's Dangerous Idea.Kenneth W. M. Fulford - 2013 - Journal of Evaluation in Clinical Practice 19 (3):537-546.
  • Deciding on Suitability for Treatment.Harry Lesser - 2013 - Journal of Evaluation in Clinical Practice 19 (3):442-446.
  • Medical Knowledge in a Social World: Introduction to the Special Issue.Bennett Holman, Sven Bernecker & Luciana Garbayo - 2019 - Synthese 196 (11):4351-4361.
    Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology.While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In addition, the broader (...)
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  • In Defense of Meta-Analysis.Bennett Holman - 2019 - Synthese 196 (8):3189-3211.
    Arguments that medical decision making should rely on a variety of evidence often begin from the claim that meta-analysis has been shown to be problematic. In this paper, I first examine Stegenga’s argument that meta-analysis requires multiple decisions and thus fails to provide an objective ground for medical decision making. Next, I examine three arguments from social epistemologists that contend that meta-analyses are systematically biased in ways not appreciated by standard epistemology. In most cases I show that critiques of meta-analysis (...)
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  • Clinical Equipoise and Moral Leeway: An Epistemological Stance.Daniele Chiffi & Ahti-Veikko Pietarinen - 2019 - Topoi 38 (2):447-456.
    Clinical equipoise has been proposed as an ethical principle relating uncertainty and moral leeway in clinical research. Although CE has traditionally been indicated as a necessary condition for a morally justified introduction of a new RCT, questions related to the interpretation of this principle remain woefully open. Recent proposals to rehabilitate CE have divided the bioethical community on its ethical merits. This paper presents a new argument that brings out the epistemological difficulties we encounter in justifying CE as a principle (...)
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  • Financializing Epistemic Norms in Contemporary Biomedical Innovation.Mark Robinson - 2019 - Synthese 196 (11):4391-4407.
    The rapid, recent emergence of new medical knowledge models has engendered a dizzying number of new medical initiatives, programs and approaches. Fields such as evidence-based medicine and translational medicine all promise a renewed relationship between knowledge and medicine. The question for philosophy and other fields has been whether these new models actually achieve their promises to bring about better kinds of medical knowledge—a question that compels scholars to analyze each model’s epistemic claims. Yet, these analyses may miss critical components that (...)
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  • Evaluating the UK House of Commons Science and Technology Committee’s Position on the Implausible Effectiveness of Homeopathic Treatments.Andrew Turner - 2017 - Theoretical Medicine and Bioethics 38 (4):335-352.
    In 2009, the UK House of Commons Science and Technology Committee conducted an ‘evidence check’ on homeopathy to evaluate evidence for its effectiveness. In common with the wider literature critical of homeopathy, the STC report seems to endorse many of the strong claims that are made about its implausibility. In contrast with the critical literature, however, the STC report explicitly does not place any weight on implausibility in its evaluation. I use the contrasting positions of the STC and the wider (...)
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  • Psychopathy: Morally Incapacitated Persons.Heidi Maibom - 2017 - In Thomas Schramme & Steven Edwards (eds.), Handbook of the Philosophy of Medicine. Dordrecht: Springer. pp. 1109-1129.
    After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...)
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  • Systematicity, Knowledge, and Bias. How Systematicity Made Clinical Medicine a Science.Alexander Bird - 2019 - Synthese 196 (3):863-879.
    This paper shows that the history of clinical medicine in the eighteenth century supports Paul Hoyningen-Huene’s thesis that there is a correlation between science and systematicity. For example, James Jurin’s assessment of the safety of variolation as a protection against smallpox adopted a systematic approach to the assessment of interventions in order to eliminate sources of cognitive bias that would compromise inquiry. Clinical medicine thereby became a science. I use this confirming instance to motivate a broader hypothesis, that systematicity is (...)
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  • Hunting Side Effects and Explaining Them: Should We Reverse Evidence Hierarchies Upside Down? [REVIEW]Barbara Osimani - 2013 - Journal of Evaluation in Clinical Practice (2):1-18.
    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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  • Problems with Using Mechanisms to Solve the Problem of Extrapolation.Jeremy Howick, Paul Glasziou & Jeffrey K. Aronson - 2013 - Theoretical Medicine and Bioethics 34 (4):275-291.
    Proponents of evidence-based medicine and some philosophers of science seem to agree that knowledge of mechanisms can help solve the problem of applying results of controlled studies to target populations (‘the problem of extrapolation’). We describe the problem of extrapolation, characterize mechanisms, and outline how mechanistic knowledge might be used to solve the problem. Our main thesis is that there are four often overlooked problems with using mechanistic knowledge to solve the problem of extrapolation. First, our understanding of mechanisms is (...)
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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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  • Understanding the Knowledge and Practice of Medicine: Papers From the Fourth Philosophy of Medicine Roundtable. [REVIEW]Jeremy R. Simon, Arantza Etxeberria & Antonio Casado da Rocha - 2013 - Theoretical Medicine and Bioethics 34 (4):253-257.
  • Fred Gifford (Ed.): Philosophy of Medicine. [REVIEW]Alexander Bird - 2013 - Theoretical Medicine and Bioethics 34 (1):53-57.
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  • The Structure of Causal Evidence Based on Eliminative Induction.Wolfgang Pietsch - 2014 - Topoi 33 (2):421-435.
    It is argued that in deterministic contexts evidence for causal relations states whether a boundary condition makes a difference or not to a phenomenon. In order to substantiate the analysis, I show that this difference/indifference making is the basic type of evidence required for eliminative induction in the tradition of Francis Bacon and John Stuart Mill. To this purpose, an account of eliminative induction is proposed with two distinguishing features: it includes a method to establish the causal irrelevance of boundary (...)
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  • Down with the Hierarchies.Jacob Stegenga - 2014 - Topoi 33 (2):313-322.
    Evidence hierarchies are widely used to assess evidence in systematic reviews of medical studies. I give several arguments against the use of evidence hierarchies. The problems with evidence hierarchies are numerous, and include methodological shortcomings, philosophical problems, and formal constraints. I argue that medical science should not employ evidence hierarchies, including even the latest and most-sophisticated of such hierarchies.
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  • The Risk GP Model: The Standard Model of Prediction in Medicine.Jonathan Fuller & Luis J. Flores - 2015 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 54:49-61.
  • Randomized Controlled Trials for Diagnostic Imaging: Conceptual and Pratical Problems.Elisabetta Lalumera & Stefano Fanti - 2019 - Topoi 38 (2):395-400.
    We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this (...)
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  • Exploring the Asymmetrical Relationship Between the Power of Finance Bias and Evidence.Jeremy Howick - 2019 - Perspectives in Biology and Medicine 62 (1):159-187.
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  • The Confounding Question of Confounding Causes in Randomized Trials.Jonathan Fuller - 2019 - British Journal for the Philosophy of Science 70 (3):901-926.
    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 (...)
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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.
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  • How to Assess the Epistemic Wrongness of Sponsorship Bias? The Case of Manufactured Certainty.Jon Leefmann - 2021 - Frontiers In 6 (Article 599909):1-13.
    Although the impact of so-called “sponsorship bias” has been the subject of increased attention in the philosophy of science, what exactly constitutes its epistemic wrongness is still debated. In this paper, I will argue that neither evidential accounts nor social–epistemological accounts can fully account for the epistemic wrongness of sponsorship bias, but there are good reasons to prefer social–epistemological to evidential accounts. I will defend this claim by examining how both accounts deal with a paradigm case from medical epistemology, recently (...)
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  • Philosophical Aspects of Evidence and Methodology in Medicine.Jesper Jerkert - 2021 - Dissertation, Royal Institute of Technology, Stockholm
    The thesis consists of an introduction and five papers. The introduction gives a brief historical survey of empirical investigations into the effectiveness of medicinal interventions, as well as surveys of the concept of evidence and of the history and philosophy of experiments. The main ideas of the EBM movement are also presented. Paper I: Concerns have been raised that clinical trials do not offer reliable evidence for some types of treatment, in particular for highly individualised treatments, for example traditional homeopathy. (...)
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  • On the Meaning of Medical Evidence Hierarchies.Jesper Jerkert - forthcoming - Philosophy of Medicine.
    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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  • A Social Epistemological Inquiry Into Biases in Journal Peer Review.Saana Jukola - 2017 - Perspectives on Science 25 (1):124-148.
    Journal peer review is an essential part of academic practices.1 But how well does it serve its purpose and which factors have an influence on how close it comes to achieving its aims? Peer review has been widely discussed in empirical literature: it has been studied both qualitatively and quantitatively (e.g., by Cole, who in his 1992 book uses data on how grant applications submitted to National Science Foundation were...
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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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  • The Ethics of Non-Inferiority Trials: A Consequentialist Analysis.Marco Annoni, Virginia Sanchini & Cecilia Nardini - 2013 - Research Ethics 9 (3):109-120.
    Discussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According to this view, (...)
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  • Knowing Times: Temporalities of Evidence for Implantable Cardioverter Defibrillators.Teun Zuiderent-Jerak & Morten Sager - 2021 - Science, Technology, and Human Values 46 (3):628-654.
    Evidence-based medicine has been studied as a rich and diverse set of epistemic and infrastructural practices that relate imperfect medical knowledges to complex clinical practices. We examine instances of medical decision-making where medical professionals relate recommendations from clinical practice guidelines to individual patient characteristics when deciding to prescribe implantable cardioverter defibrillators to treat heart failure. When connecting evidence-based recommendations to decisions about individual patients, we find that clinical deliberations invoke different times, such as linear, chronological time, and biological aging, as (...)
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  • Broadening the Scope of Our Understanding of Mechanisms: Lessons From the History of the Morning-After Pill.Christopher ChoGlueck - 2019 - Synthese 198 (3):2223-2252.
    Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections (...)
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