Obviously medicine should be evidence-based. The issues lie in the details: what exactly counts as evidence? Do certain kinds of evidence carry more weight than others? (And if so why?) And how exactly should medicine be based on evidence? When it comes to these details, the evidence-based medicine (EBM) movement has got itself into a mess – or so it will be argued. In order to start to resolve this mess, we need to go 'back to basics'; and that means (...) turning to the philosophy of science. The theory of evidence, or rather the logic of the interrelations between theory and evidence, has always been central to the philosophy of science – sometimes under the alias of the 'theory of confirmation'. When taken together with a little philosophical commonsense, this logic can help us move towards a position on evidence in medicine that is more sophisticated and defensible than anything that EBM has been able so far to supply. (shrink)

This paper presents a counterfactual account of what a mechanism is. Mechanisms consist of parts, the behavior of which conforms to generalizations that are invariant under interventions, and which are modular in the sense that it is possible in principle to change the behavior of one part independently of the others. Each of these features can be captured by the truth of certain counterfactuals.

This paper presents a counterfactual account of what a mechanism is. Mechanisms consist of parts, the behavior of which conforms to generalizations that are invariant under interventions, and which are modular in the sense that it is possible in principle to change the behavior of one part independently of the others. Each of these features can be captured by the truth of certain counterfactuals.

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five (...) distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

Stuart Glennan, and the team of Peter Machamer, Lindley Darden, and Carl Craver have recently provided two accounts of the concept of a mechanism. The main difference between these two versions rests on how the behavior of the parts of the mechanism is conceptualized. Glennan considers mechanisms to be an interaction of parts, where the interaction between parts can be characterized by direct, invariant, change-relating generalizations. Machamer, Darden, and Craver criticize traditional conceptualizations of mechanisms which are based solely on parts (...) interacting and introduce a new conceptactivity. This essay is an attempt at carving out a relationship between these two philosophical interpretations of a mechanism. I will claim that, rather than being in conflict, Glennan's concept of interaction and Machamer, Darden, and Craver's notion of activity actually complement one another, each emphasizing a missing element of the other. (shrink)

In order to make scientific results relevant to practical decision making, it is often necessary to transfer a result obtained in one set of circumstances—an animal model, a computer simulation, an economic experiment—to another that may differ in relevant respects—for example, to humans, the global climate, or an auction. Such inferences, which we can call extrapolations, are a type of argument by analogy. This essay sketches a new approach to analogical inference that utilizes chain graphs, which resemble directed acyclic graphs (...) (DAGs) except in allowing that nodes may be connected by lines as well as arrows. This chain graph approach generalizes the account of extrapolation I provided in my (2008) book and leads to new insights that integrate the contributions of the other participants of this symposium. More specifically, this approach explicates the role of “fingerprints,” or distinctive markers, as a strategy for avoiding an underdetermination problem having to do with spurious analogies. Moreover, it shows how the extrapolator’s circle, one of the central challenges for extrapolation highlighted in my book, is closely tied to distinctive markers and the Markov condition as it applies to chain graphs. Finally, the approach suggests additional ways in which investigations of a model can provide information about a target that are illustrated by examples concerning nanomaterials in sunscreens and Wendy Parker’s discussion of fingerprints in climate science. (shrink)

Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical literature. It (...) finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)

We argue that the health sciences make causal claims on the basis of evidence both of physical mechanisms, and of probabilistic dependencies. Consequently, an analysis of causality solely in terms of physical mechanisms or solely in terms of probabilistic relationships, does not do justice to the causal claims of these sciences. Yet there seems to be a single relation of cause in these sciences - pluralism about causality will not do either. Instead, we maintain, the health sciences require a theory (...) of causality that unifies its mechanistic and probabilistic aspects. We argue that the epistemic theory of causality provides the required unification. (shrink)

The concept of mechanism is analyzed in terms of entities and activities, organized such that they are productive of regular changes. Examples show how mechanisms work in neurobiology and molecular biology. Thinking in terms of mechanisms provides a new framework for addressing many traditional philosophical issues: causality, laws, explanation, reduction, and scientific change.

This article deals with mechanisms conceived as composed of entities and activities. In response to many perplexities about the nature of activities, a number of arguments are developed concerning their epistemic and ontological status. Some questions concerning the relations between cause and causal explanation and mechanisms are also addressed.

The experimental approach in economics is a driving force behind some of the most exciting developments in the field. The 'experimental revolution' was based on a series of bold philosophical premises which have remained until now mostly unexplored. This book provides the first comprehensive analysis and critical discussion of the methodology of experimental economics, written by a philosopher of science with expertise in the field. It outlines the fundamental principles of experimental inference in order to investigate their power, scope and (...) limitations. The author demonstrates that experimental economists have a lot to gain by discussing openly the philosophical principles that guide their work, and that philosophers of science have a lot to learn from their ingenious techniques devised by experimenters in order to tackle difficult scientific problems. (shrink)

Biomedical researchers claim there is significant biomedical information about humans which can be discovered only through experiments on intact animal systems (AMA p. 2). Although epidemiological studies, computer simulations, clinical investigation, and cell and tissue cultures have become important weapons in the biomedical scientists' arsenal, these are primarily "adjuncts to the use of animals in research" (Sigma Xi p. 76). Controlled laboratory experiments are the core of the scientific enterprise. Biomedical researchers claim these should be conducted on intact biological systems, (...) whole animals. By observing the effects of various stimuli in non-human animals, we can form legitimate expectations about the likely effects of these stimuli in humans. Perhaps more importantly, we can understand the biomedical condition's causal mechanisms. (shrink)

Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Yet evidence about mechanisms does not feature on dominant evidence-based medicine “hierarchies.” After arguing that only inferences from mechanisms (“mechanistic reasoning”)—not mechanisms themselves—count as evidence, I argue for a middle ground. Mechanistic reasoning is not required to establish causation when we have high-quality controlled studies; moreover, mechanistic reasoning is more problematic than has been assumed. Yet where the problems can (...) be overcome, mechanistic reasoning can and should be used as evidence. (shrink)

Comparative process tracing is the best analysis of extrapolation inferences in the philosophical and scientific literature so far. In this essay I examine some similarities and differences between comparative process tracing and former attempts to capture the logic of extrapolation, such as the analogical approach. I show that these accounts are not different in spirit, although comparative process tracing supersedes previous proposals in terms of analytical detail. I also examine some qualms about the possibility of drawing extrapolation inferences in the (...) social sciences and conclude by suggesting that there may be cases of extrapolation without process tracing. (shrink)

Philosophers of science typically associate the causal-mechanical view of scientific explanation with the work of Railton and Salmon. In this paper I shall argue that the defects of this view arise from an inadequate analysis of the concept of mechanism. I contrast Salmon's account of mechanisms in terms of the causal nexus with my own account of mechanisms, in which mechanisms are viewed as complex systems. After describing these two concepts of mechanism, I show how the complex-systems approach avoids certain (...) objections to Salmon's account of causal-mechanical explanation. I conclude by discussing how mechanistic explanations can provide understanding by unification. (shrink)

Philosophers of science typically associate the causal-mechanical view of scientific explanation with the work of Railton and Salmon. In this paper I shall argue that the defects of this view arise from an inadequate analysis of the concept of mechanism. I contrast Salmon's account of mechanisms in terms of the causal nexus with my own account of mechanisms, in which mechanisms are viewed as complex systems. After describing these two concepts of mechanism, I show how the complex-systems approach avoids certain (...) objections to Salmon's account of causal-mechanical explanation. I conclude by discussing how mechanistic explanations can provide understanding by unification. (shrink)

In this paper I offer an analysis of causation based upon a theory of mechanisms-complex systems whose internal parts interact to produce a system's external behavior. I argue that all but the fundamental laws of physics can be explained by reference to mechanisms. Mechanisms provide an epistemologically unproblematic way to explain the necessity which is often taken to distinguish laws from other generalizations. This account of necessity leads to a theory of causation according to which events are causally related when (...) there is a mechanism that connects them. I present reasons why the lack of an account of fundamental physical causation does not undermine the mechanical account. (shrink)

This article addresses the question of whether we should conceive of mechanisms as productive of change in a regular way. I argue that, if mechanisms are characterized as fully regular, on the one hand, then not enough processes will count as mechanisms for them to be interesting or useful. If no appeal to regularity is made at all in their characterization, on the other hand, then mechanisms can no longer be useful for grounding prediction and supporting intervention strategies. I conclude (...) that, if the New Mechanistic Philosophy is to be successful, a stochastic characterization of mechanisms must be adopted. (shrink)

Philosophers of science typically associate the causal‐mechanical view of scientific explanation with the work of Railton and Salmon. In this paper I shall argue that the defects of this view arise from an inadequate analysis of the concept of mechanism. I contrast Salmon’s account of mechanisms in terms of the causal nexus with my own account of mechanisms, in which mechanisms are viewed as complex systems. After describing these two concepts of mechanism, I show how the complex‐systems approach avoids certain (...) objections to Salmon’s account of causal‐mechanical explanation. I conclude by discussing how mechanistic explanations can provide understanding by unification. (shrink)

There is a takeover movement fast gaining influence in development economics, a movement that demands that predictions about development outcomes be based on randomized controlled trials. The problem it takes up—of using evidence of efficacy from good studies to predict whether a policy will be effective if we implement it—is a general one, and affects us all. My discussion is the result of a long struggle to develop the right concepts to deal with the problem of warranting effectiveness predictions. Whether (...) I have it right or not, these are questions of vast social importance that philosophers of science can, and should, help answer. (shrink)

Ever since David Hume, empiricists have barred powers and capacities from nature. In this book Cartwright argues that capacities are essential in our scientific world, and, contrary to empiricist orthodoxy, that they can meet sufficiently strict demands for testability. Econometrics is one discipline where probabilities are used to measure causal capacities, and the technology of modern physics provides several examples of testing capacities (such as lasers). Cartwright concludes by applying the lessons of the book about capacities and probabilities to the (...) explanation of the role of causality in quantum mechanics. (shrink)

Nineteenth-century medical advances were entwined with a conceptual innovation: the idea that many cases of disease which were previously thought to have diverse causes could be explained by the action of a single kind of cause, for example a certain bacterial or parasitic infestation. The focus of modern epidemiology, however, is on chronic non-communicable diseases, which frequently do not seem to be attributable to any single causal factor. This paper is an effort to resolve the resulting tension. The paper criticises (...) the monocausal model of disease, so successful in the nineteenth century. It also argues that a multifactorial model of disease can only be satisfactory if it amounts to more than a mere rejection of the monocausal model. A third alternative, the contrastive model, is proposed and defended on the grounds that it links the notions of disease and of general explanation, while avoiding the philosophical naiveties and practical difficulties of the monocausal model. (shrink)

Machamer, Darden, and Craver argue that causal explanations explain effects by describing the operations of the mechanisms which produce them. One of this paper’s aims is to take advantage of neglected resources of Mechanism to rethink the traditional idea that actual or counterfactual natural regularities are essential to the distinction between causal and non-causal co-occurrences, and that generalizations describing natural regularities are essential components of causal explanations. I think that causal productivity and regularity are by no means the same thing, (...) and that the Regularists are mistaken about the roles generalizations play in causal explanation. Humean, logical empiricist, and other Regularist accounts of causal explanation have had the unfortunate effect of distracting philosophers’ from important non-explanatory scientific uses of laws and lesser generalizations which purport to describe natural regularities. My second aim is to characterize some of these uses, illustrating them with examples from neuroscientific research. (shrink)

Explanations in the life sciences frequently involve presenting a model of the mechanism taken to be responsible for a given phenomenon. Such explanations depart in numerous ways from nomological explanations commonly presented in philosophy of science. This paper focuses on three sorts of differences. First, scientists who develop mechanistic explanations are not limited to linguistic representations and logical inference; they frequently employ diagrams to characterize mechanisms and simulations to reason about them. Thus, the epistemic resources for presenting mechanistic explanations are (...) considerably richer than those suggested by a nomological framework. Second, the fact that mechanisms involve organized systems of component parts and operations provides direction to both the discovery and testing of mechanistic explanations. Finally, models of mechanisms are developed for specific exemplars and are not represented in terms of universally quantified statements. Generalization involves investigating both the similarity of new exemplars to those already studied and the variations between them. (shrink)

The basic principles of scientific research from the great French physiologist whose contributions in the 19th century included the discovery of vasomotor nerves; nature of curare and other poisons in human body; more.

"This is a wonderful book! In "How Scientists Explain Disease," Paul Thagard offers us a delightful essay combining science, its history, philosophy, and sociology.

The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness -- Questioning (...) the methodological superiority of "placebo" over "active" controlled trials -- Examining the paradox that traditional roles for mechanistic reasoning and expert -- Judgment have been up-ended by EBM -- A qualified defence of the EBM stance on mechanistic reasoning -- Knowledge that versus knowledge how : situating the EBM position on expert clinical judgment -- Moving EBM forward. (shrink)

Inferences like these are known as extrapolations.

Knowledge of causal laws is expensive and hard to come by. But we work hard to get it because we believe that it will reduce contingency in planning policies and in building new technologies: knowledge of causal laws allows us to predict reliably what the outcomes will be when we manipulate the factors cited as causes in those laws. Or do they? This paper will argue that causal laws have no special role here. As economists from JS Mill to Robert (...) Lucas and David Hendry stress, along recently with philosophers like James Woodward and Sandra Mitchell, they can do the job only if they are invariant under the manipulations proposed. But then, I shall argue, anything that is invariant under the proposed manipulations will do this job equally well. There seems to be nothing special about causal-law knowledge in and of itself that makes it particularly valuable for policy and technology prediction. What seems to matter is invariance alone, not causality. But what guarantees invariance and how do we know when it will obtain? Here certain kinds of causal laws do have a special place – those underwritten either by what I have called ‘nomological machines’ or by what I have called ‘capacities’. Capacities and nomological machines have a double virtue that makes them invaluable for policy planning. First, the causal laws they give rise to will be invariant so long as they obtain; and second, they typically have visible markers we can come to recognize that tell us when they obtain. The markers for nomological machines are shakier than those for capacities, though, since capacities are often tied to markers by well-established empirical laws. Capacities have their own drawback however, which is the final topic of this paper: the causal laws that are guaranteed by a capacity connect the obtaining (or triggering) of a capacity with its exercise. But Hume argued (mistakenly I suggest) that no distinction can be made between the obtaining of a power and its exercise. (shrink)

Knowledge of causal laws is expensive and hard to come by. But we work hard to get it because we believe that it will reduce contingency in planning policies and in building new technologies: knowledge of causal laws allows us to predict reliably what the outcomes will be when we manipulate the factors cited as causes in those laws. Or do they? This paper will argue that causal laws have no special role here. As economists from JS Mill to Robert (...) Lucas and David Hendry stress, along recently with philosophers like James Woodward and Sandra Mitchell, they can do the job only if they are invariant under the manipulations proposed. But then, I shall argue, anything that is invariant under the proposed manipulations will do this job equally well. There seems to be nothing special about causal-law knowledge in and of itself that makes it particularly valuable for policy and technology prediction. What seems to matter is invariance alone, not causality. But what guarantees invariance and how do we know when it will obtain? Here certain kinds of causal laws do have a special place – those underwritten either by what I have called ‘nomological machines’ or by what I have called ‘capacities’. Capacities and nomological machines have a double virtue that makes them invaluable for policy planning. First, the causal laws they give rise to will be invariant so long as they obtain; and second, they typically have visible markers we can come to recognize that tell us when they obtain. The markers for nomological machines are shakier than those for capacities, though, since capacities are often tied to markers by well-established empirical laws. Capacities have their own drawback however, which is the final topic of this paper: the causal laws that are guaranteed by a capacity connect the obtaining of a capacity with its exercise. But Hume argued that no distinction can be made between the obtaining of a power and its exercise. (shrink)