Placebo-controlled trials are held by many, including regulators at agencies like the United States Food and Drug Administration, to be the gold standard in the assessment of new medical interventions. Yet the use of placebo controls in clinical trials has been the focus of considerable controversy. In this two-part article, we challenge a number of common beliefs concerning the value of placebo controls. Part I critiques statistical and other scientific justifications for the use of placebo controls in clinical research. The (...) continued use of placebo controls in clinical trials on diseases for which accepted treatment exists raises equally important ethical, legal, and regulatory issues for which various justifications have been given. Defense of this practice relies on normative as well as empirical myths.In their attack on the prevailing use of placebo controls, Kenneth Rothman and Karin Michels emphasize that this practice stands in violation of the World Medical Association's guidelines on the ethics of human experimentation, most commonly known as the Helsinki Declaration. (shrink)

The use of statistics in medical research has been compared to a religion: it has its high priests, supplicants, and orthodoxy. Although the comparison may be more unfair to religion than to research, a useful lesson can nonetheless be drawn: the practice of clinical research may benefit—as does the spirit—from critical self-examination. Arguably, no aspect of the conduct of clinical trials is currently more controversial—and thus in as dire need of critical examination—than the use of placebo controls. The ethical and (...) scientific controversies associated with placebo-controlled trials, never far below the surface, have once again seized public attention. Clearly, concern about these issues within the professional community runs deep and wide, as evidenced by the volume of response generated by Kenneth Rothman and Karin Michels's recent Critique. Criticisms of the use of placebo controls in clinical research are scattered through the literatureo; our objective is to present the case against placebos in a compendious form that takes account of scientific and statistical as well as normative issues. (shrink)

Placebo-controlled trials are held by many, including regulators at agencies like the United States Food and Drug Administration, to be the gold standard in the assessment of new medical interventions. Yet the use of placebo controls in clinical trials has been the focus of considerable controversy. In this two-part article, we challenge a number of common beliefs concerning the value of placebo controls. Part I critiques statistical and other scientific justifications for the use of placebo controls in clinical research. The (...) continued use of placebo controls in clinical trials on diseases for which accepted treatment exists raises equally important ethical, legal, and regulatory issues for which various justifications have been given. Defense of this practice relies on normative as well as empirical myths.In their attack on the prevailing use of placebo controls, Kenneth Rothman and Karin Michels emphasize that this practice stands in violation of the World Medical Association's guidelines on the ethics of human experimentation, most commonly known as the Helsinki Declaration. (shrink)

The use of statistics in medical research has been compared to a religion: it has its high priests, supplicants, and orthodoxy. Although the comparison may be more unfair to religion than to research, a useful lesson can nonetheless be drawn: the practice of clinical research may benefit—as does the spirit—from critical self-examination. Arguably, no aspect of the conduct of clinical trials is currently more controversial—and thus in as dire need of critical examination—than the use of placebo controls. The ethical and (...) scientific controversies associated with placebo-controlled trials, never far below the surface, have once again seized public attention. Clearly, concern about these issues within the professional community runs deep and wide, as evidenced by the volume of response generated by Kenneth Rothman and Karin Michels's recent Critique. Criticisms of the use of placebo controls in clinical research are scattered through the literatureo; our objective is to present the case against placebos in a compendious form that takes account of scientific and statistical as well as normative issues. (shrink)

In this powerful memoir, philosopher Karyn L. Freedman travels back to a Paris night in 1990 when she was twenty-two and, in one violent hour, her life was changed forever by a brutal rape. _One Hour in Paris_ takes the reader on a harrowing yet inspirational journey through suffering and recovery both personal and global. We follow Freedman from an apartment in Paris to a French courtroom, then from a trauma center in Toronto to a rape clinic in (...) Africa. At a time when as many as one in three women in the world have been victims of sexual assault and when many women are still ashamed to come forward, Freedman’s book is a moving and essential look at how survivors cope and persevere. At once deeply intimate and terrifyingly universal, _One Hour in Paris _weaves together Freedman’s personal experience with the latest philosophical, neuroscientific, and psychological insights on what it means to live in a body that has been traumatized. Using her background as a philosopher, she looks at the history of psychological trauma and draws on recent theories of posttraumatic stress disorder and neuroplasticity to show how recovery from horrific experiences is possible. Through frank discussions of sex and intimacy, she explores the consequences of sexual violence for love and relationships, and she illustrates the steep personal cost of sexual violence and the obstacles faced by individual survivors in its aftermath. Freedman’s book is an urgent call to face this fundamental social problem head-on, arguing that we cannot continue to ignore the fact that sexual violence against women is rooted in gender inequalities that exist worldwide—and must be addressed. _One Hour in Paris_ is essential reading for survivors of sexual violence as well as an invaluable resource for therapists, mental health professionals, and family members and friends of victims. (shrink)

It is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective. In this paper, I critically evaluate Benjamin (...) Freedman's 'clinical equipoise' solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts - one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise - and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified - a 'sliding-scale equipoise' that arises out of a discussion of patients' values. (shrink)

There have been many efforts to infer causation from association byusing statistical models. Algorithms for automating this processare a more recent innovation. In Humphreys and Freedman[(1996) British Journal for the Philosophy of Science 47, 113–123] we showed that one such approach, by Spirtes et al., was fatally flawed. Here we put our arguments in a broader context and reply to Korb and Wallace [(1997) British Journal for thePhilosophy of Science 48, 543–553] and to Spirtes et al.[(1997) British Journal for (...) the Philosophy of Science 48, 555–568]. Their arguments leave our position unchanged: claims to have developed a rigorous engine for inferring causation from association are premature at best, the theorems have no implications for samples of any realistic size, and the examples used to illustrate the algorithms are indicative of failure rather than success. The gap between association and causation has yet to be bridged. (shrink)

An educational intervention using forgiveness as the goal was implemented with 10 at-risk adolescents attending an alternative school in a Midwestern city. The adolescents ranged in age from 15 to 19 years of age. A randomized experimental and active control group pre- and post-test design was used. Twenty-one participants were randomly assigned to either the experimental group or the control group. Classes met daily for 31 sessions for approximately 23 hours of education. Enright’s process model of forgiveness was used as (...) the focus of the intervention. Dependent variables included forgiveness, self-esteem, hope, depression, and state-trait anxiety scales. After the education, the experimental group gained more than the control group in forgiveness and hope, and decreased significantly more than the control group in anxiety and depression. Verbal reports from the experimental participants following the education also illustrate the positive impact forgiveness had on the students. (shrink)

This essay explores the epistemological significance of the kinds of beliefs that grow out of traumatic experiences, such as the rape survivor's belief that she is never safe. On current theories of justification, beliefs like this one are generally dismissed due to either insufficient evidence or insufficient propositional content. Here, Freedman distinguishes two discrete sides of the aftermath of psychic trauma, the shattered self and the shattered worldview. This move enables us to see these beliefs as beliefs; in other (...) words, as having cognitive content. Freedman argues that what we then need is a theory of justification that allows us to handpick reliable sources of information on sexual violence, and give credibility where deemed appropriate. She advances a mix of reliabilism and coherentism that privileges feminism. On this account, the evidence for the class of beliefs in question will depend on an act of sexual violence (or testimony, or statistics) to the extent that the act is a reliable indication of the prevalence of sexual violence against women. (shrink)

Helen Longino argues that the way to ensure scientific knowledge is objective is to have a diversity of scientific investigators. This is the best example of recent feminist arguments which hold that the real value of diversity is epistemic, and not political, but it only partly succeeds. In the end, Longino's objectivity amounts to intersubjective agreement about contextually based standards, and while her account gives us a good reason for wanting diversity in our scientific communities, this reason turns out to (...) be political. (shrink)

In this paper, I give an answer to the central epistemic question regarding the normative requirements for beliefs based on testimony. My suggestion here is that our best strategy for coming up with the conditions for justification is to look at cases where the adoption of the belief matters to the person considering it. This leads me to develop, in Part One of the paper, an interest-relative theory of justification, according to which our justification for a proposition p depends on (...) our evidence in favour of p in proportion to our interest in p, as signalled by the epistemic risk we take in believing that p is true. In Part Two, I argue that this theory shows that the reductivist view offers a better normative account for the epistemic status of beliefs based on testimony than the credulist one, but it is inaptly named; the view I develop here is better conceived of as The Dependence Account. (shrink)

In this paper I respond to Rebecca Kukla's (2014) "Commentary on Karyn Freedman, "Testimony and Epistemic Risk: The Dependence Account."".

Duty and Healing positions ethical issues commonly encountered in clinical situations within Jewish law. The concept of duty is significant in exploring bioethical issues, and this book presents an authentic and non-parochial Jewish approach to bioethics, while it includes critiques of both current secular and Jewish literatures. Among the issues the book explores are the role of family in medical decision-making, the question of informed consent as a personal religious duty, and the responsibilities of caretakers. The exploration of contemporary ethical (...) problems in healthcare through the lens of traditional sources in Jewish law is an indispensable guide of moral knowledge. (shrink)

After sketching the conflict between objectivists and subjectivists on the foundations of statistics, this paper discusses an issue facing statisticians of both schools, namely, model validation. Statistical models originate in the study of games of chance, and have been successfully applied in the physical and life sciences. However, there are basic problems in applying the models to social phenomena; some of the difficulties will be pointed out. Hooke's law will be contrasted with regression models for salary discrimination, the latter being (...) a fairly typical application in the social sciences. (shrink)

Individual objects have potentials: paper has the potential to burn, an acorn has the potential to turn into a tree, some people have the potential to run a mile in less than four minutes. Barbara Vetter provides a systematic investigation into the metaphysics of such potentials, and an account of metaphysical modality based on them. -/- In contemporary philosophy, potentials have been recognized mostly in the form of so-called dispositions: solubility, fragility, and so on. Vetter takes dispositions as her (...) starting point, but argues for and develops a more comprehensive conception of potentiality. She shows how, with this more comprehensive conception, an account of metaphysical modality can be given that meets three crucial requirements: Extensional correctness: providing the right truth-values for statements of possibility and necessity; formal adequacy: providing the right logic for metaphysical modality; and semantic utility: providing a semantics that links ordinary modal language to the metaphysics of modality. -/- The resulting view of modality is a version of dispositionalism about modality: it takes modality to be a matter of the dispositions of individual objects. This approach has a long philosophical tradition going back to Aristotle, but has been largely neglected in contemporary philosophy. In recent years, it has become a live option again due to the rise of anti-Humean, powers-based metaphysics. The aim of Potentiality is to develop the dispositionalist view in a way that takes account of contemporary developments in metaphysics, logic, and semantics. (shrink)

ABSTRACT: Looking at specific populations of knowers reveals that the presumption of sameness within knowledge communities can lead to a number of epistemological oversights. A good example of this is found in the case of survivors of sexual violence. In this paper I argue that this case study offers a new perspective on the debate between the epistemic internalist and externalist by providing us with a fresh insight into the complicated psychological dimensions of belief formation and the implications that this (...) has for an epistemology that demands reasons that are first-person accessible. RÉSUMÉ: L’observation de populations spécifiques d’agents épistémiques révèle que la présomption d’identité au sein de communautés épistémiques peut mener à certaines omissions cognitives. Les victimes de violence sexuelle en sont un bon exemple. Cette étude de cas offre selon nous une nouvelle perspective sur le débat entre les internalistes et les externalistes en épistémologie en proposant une nouvelle perspective sur les dimensions psychologiques complexes dans la formation des croyances et sur leur implication dans une épistémologie qui nécessite que les raisons soient accessibles à la première personne. (shrink)

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to (...) the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas. (shrink)

Criticisms have been made against international laws and conventions on asylum and refugees, arguing that these have been based on a male model of definition, which have ignored women’s persecutions. This article will argue that recent developments in European asylum policy have the potential to deepen this discrimination and to further reduce the rights of female asylum seekers. Although there have been some positive developments in jurisprudence that have recognised that gender-specific persecution may be the basis for granting asylum, these (...) advances remain relatively sporadic and are undermined by the operation of random and discretionary exercises of power by bureaucrats and decision makers in many cases. Further, although new developments in asylum policy are in theory “gender neutral,” differences in the material circumstances of men and women who arrive to seek asylum may mean in effect that the implications of these policies are deeply gendered. (shrink)

Criticisms have been made against international laws and conventions on asylum and refugees, arguing that these have been based on a male model of definition, which have ignored women’s persecutions. This article will argue that recent developments in European asylum policy have the potential to deepen this discrimination and to further reduce the rights of female asylum seekers. Although there have been some positive developments in jurisprudence that have recognised that gender-specific persecution may be the basis for granting asylum, these (...) advances remain relatively sporadic and are undermined by the operation of random and discretionary exercises of power by bureaucrats and decision makers in many cases. Further, although new developments in asylum policy are in theory “gender neutral,” differences in the material circumstances of men and women who arrive to seek asylum may mean in effect that the implications of these policies are deeply gendered. (shrink)

How does thinking affect doing? There is a widely held view that thinking about what you are doing, as you are doing it, hinders performance. Once you have acquired the ability to putt a golf ball, play an arpeggio on the piano, or parallel-park, reflecting on your actions leads to inaccuracies, blunders, and sometimes even utter paralysis--that's what is widely believed. But is it true? After exploring some of the contemporary and historical manifestations of the idea, Barbara Gail Montero (...) develops a theory of expertise which emphasizes the role of the conscious mind in expert action. She aims to dispel various myths about experts who proceed without any understanding of what guides their action, and she analyzes research in both philosophy and psychology that is taken to show that conscious control and explicit monitoring of one's movements impedes well practiced skills. Montero explores a wide range of real-life examples of optimal performance, in sports, the performing arts, healthcare, the military, and other fields, and draws from psychology, neuroscience, and literature to offer a refreshing and persuasive view of expertise, according to which expert action generally is and ought to be thoughtful, effortful, and reflective. (shrink)

Doppelt (1986,1990), Siegel (1990), and Rosenberg (1996) argue that the pivotal feature of Laudan's normative naturalism, namely his axiology, lacks a naturalistic foundation. In this paper I show that this objection turns on a misunderstanding of Laudan's use of the term 'naturalism'. Specifically, I argue that there are two important senses of naturalism running through Laudan's work. Once these two strands are made explicit, the objection raised by Doppelt and others simply disappears.

Cheryl Misak argues that since disquotationalism cannot distinguish between different kinds of declarative sentences it cannot make sense of the disciplined nature of moral discourse. This apparent weakness is overcome by her pragmatist theory of truth, which reinflates truth by linking it to our everyday practices of justification and verification. In this paper I argue that the criticism that a deflated notion of truth cannot capture our justificatory practices has no purchase with someone who has no such aspirations for the (...) truth predicate, and I go on to argue that this points to a more serious problem with Misak’s pragmatist theory of truth, namely her desire to explicate justification in terms of truth. The burden of making sense of debates in the moral realm lies not with the truth theorist, but elsewhere. Misak is right that moral claims demand greater justification than certain other sorts of declarative sentences, but the best explanation for this is the nature of the subject matter introduced by a claim to which the predicate ‘true’ is then applied. (shrink)

In Causation, Prediction, and Search, we undertook a three part project. First, we characterized when causal models are indistinguishable by population conditional independence relations under several different assumptions relating causality to probability. Second, we proposed a number of algorithms that take sample data and optional background knowledge as input, and output a class of causal models compatible with the data and the background knowledge; the algorithms were accompanied by proofs of their correctness given assumptions that were clearly stated in CPS, (...) and that we will restate below. Finally, we offered a theory of how to predict the effects of interventions in causal structures, given only partial knowledge of causal structure. Freedman's objections are all directed against the causal inference algorithms we proposed. We do not have room here to discuss all of his criticisms, but we have answered his major points. With regard to the points we do not have room to discuss, the reader should be warned that Freedman is an unreliable interpreter of what we have written. For convenience, we have divided Freedman's objections into the following categories. 1.) Freedman questions some of the assumptions on which our correctness theorems are based. Some of his criticisms are based on covariance matrices that he constructed. None of the examples he constructed in sections 11.2, 11.3, or 12.3 are counterexamples to any theorem that we stated, nor are they even germane to the question of how probable are the assumptions we make. His examples only illustrate points discussed in detail in our book, in which we give similar examples. 2.) The most serious charge that Freedman makes is that the algorithms do not compute what we say they do. (shrink)