The use of evidence in medicine is something we should continuously seek to improve. This book seeks to develop our understanding of evidence of mechanism in evaluating evidence in medicine, public health, and social care; and also offers tools to help implement improved assessment of evidence of mechanism in practice. In this way, the book offers a bridge between more theoretical and conceptual insights and worries about evidence of mechanism and practical means to fit the results into evidence assessment procedures.
Evidence-based medicine has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.
The role of mechanistic evidence tends to be under‐appreciated in current evidence‐based medicine, which focusses on clinical studies, tending to restrict attention to randomized controlled studies when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available. Nevertheless, we argue that mechanistic evidence is central to all (...) the key tasks in the drug approval process: in drug discovery and development; assessing pharmaceutical quality; devising dosage regimens; assessing efficacy, harms, external validity, and cost‐effectiveness; evaluating adherence; and extending product licences. We recommend that, when preparing for meetings in which any aspect of drug approval is to be discussed, mechanistic evidence should be systematically analysed and presented to the committee members alongside analyses of clinical studies. (shrink)
Grief research in philosophy agrees that one who grieves grieves over the irreversible loss of someone whom the griever loved deeply, and that someone thus factored centrally into the griever’s sense of purpose and meaning in the world. The analytic literature in general tends to focus its treatments on the paradigm case of grief as the death of a loved one. I want to restrict my account to the paradigm case because the paradigm case most persuades the mind that grief (...) is a past-directed emotion. The phenomenological move I propose will enable us to respect the paradigm case of grief and a broader but still legitimate set of grief-generating states of affairs, liberate grief from the view that grief is past directed or about the past, and thus account for grief in a way that separates it from its closest emotion-neighbor, sorrow, without having to rely on the affective quality of those two emotions.If the passing of the beloved causes the grief but is not what the grief is about, then we can get at the nature of grief by saying its temporal orientation is in the past, but its temporal meaning is the present and future—the new significance of a world with the pervasive absence that is the world without the beloved. The no-longer of grief is a no-longer oriented by a past that is referred a present and future. Looking at the griever’s relation to time can tell us much about the pain and the object of grief, then. As the griever puts the past before himself with a certainty about this world “henceforth,” a look at the griever’s lived sense of the fi nality of the irreversibly lost liberates grief from the tendency in the literature to be reduced to a past-directed emotion, accounts for grief ’s intensity, its affective force or poignancy, and thus enables us to separate grief from sorrow according to its intentionalobject in light of the temporal meaning of these emotions. (shrink)
Evidence-based medicine, the dominant approach to assessing the effectiveness of clinical and public health interventions, focuses on the results of association studies. EBM+ is a development of EBM that systematically considers mechanistic studies alongside association studies. In this paper we provide several examples of the importance of mechanistic evidence to coronavirus research. Assessment of combination therapy for MERS highlights the need for systematic assessment of mechanistic evidence. That hypertension is a risk factor for severe disease in the case of SARS-CoV-2 (...) suggests that altering hypertension treatment might alleviate disease, but the mechanisms are complex, and it is essential to consider and evaluate multiple mechanistic hypotheses. To be confident that public health interventions will be effective requires a detailed assessment of social and psychological components of the mechanisms of their action, in addition to mechanisms of disease. In particular, if vaccination programmes are to be effective, they must be carefully tailored to the social context; again, mechanistic evidence is crucial. We conclude that coronavirus research is best situated within the EBM+ evaluation framework. (shrink)
This paper presents Anthony Steinbock's broad theory of moral emotions and specifically the distinction he draws between the temporal orientation and the temporal meaning of emotions. The latter distinction is used in order to provide phenomenological descriptions of, and distinctions between, patience and impatience. The paper takes leading clues from Steinbock’s work in an effort to “do” phenomenology in a way that clarifies these specific natural attitude intentionalities.
Following an analysis of the work of Stanley Cavell, Arthur Danto, Umberto Eco, Susan Sontag, and other philosophers of the 1960s who made aesthetics more responsive to contemporary art, Kelly considers Sontag's aesthetics in greater detail ...
One of the guiding principles of modern medical and health sciences is the discovery and description of the modes of origin and the actions of pathogenic precursors of disease. This principle facilitates the design of interventions to reduce the burden of mortality and morbidity in individuals and populations. This enterprise is challenging because of the complexity of the pathogenic mechanisms involved. Although highly intricate descriptions of these mechanisms have been developed, they have mainly been at the biological level. In this (...) article, we focus on a relatively underexplored aspect of the complexity of pathogenic process: the integration of biological with social and behavioral causes in the same.. (shrink)
Arthur C. Danto has long defended essentialism in the philosophy of art, yet he has been interpreted by many as a historicist. This essentialism/historicism conflict in the interpretation of his work reflects the same conflict both within his thought and, more importantly, within modern art itself. Danto's strategy for resolving this conflict involves, among other things, a Bildungsroman of modern art failing to discover its essence, an essentialist definition of art provided by philosophy which is indemnified against history, and a (...) thesis about the end of art once it has been defined. Is this strategy successful, or does it result, as I argue, in a philosophical disenfranchisement of art of precisely the type that Danto himself has criticized? (shrink)
The first reference of its kind surveys the full breadth of critical thought on art, culture, and society--from classical philosophy to contemporary critical theory. Featuring 600 original articles by distinguished scholars from many fields and countries, it is a comprehensive survey of major concepts, thinkers, and debates about the meaning, uses, and value of all the arts--from painting and sculpture to literature, music, theater, dance, television, film, and popular culture. Of special interest are in-depth surveys of Western aesthetics and broad (...) coverage of non-Western traditions and theories of art. The work includes cross references, bibliographies, and an index. (shrink)
Ricoeur’s text divides into three parts corresponding to its title: the phenomenology of memory; the epistemology of history; and the hermeneutics of the human historical condition, its “emblem of vulnerability” being “forgetting”. That the words “memory” and “history” appear in the title proves unsurprising. But what of the title’s final word, “forgetting”? The putative “duty of memory” to “not forget” relegates forgetting to a via negativa, the “reverse side of memory”. Ricoeur, however, raises the prospect of a “right of forgetting”, (...) “a positive meaning” for forgetting that entails the “spirit of forgiveness” and “reconciliation”. By reconsidering forgetting, Ricoeur moves toward the praxis of forgiveness beyond epistemological reflections—including the phenomenology of memory and totalizing, Hegelian philosophies of history —and utilitarian ethico-politics, and redresses lacunae in Time and Narrative and Oneself as Another. (shrink)
Those familiar with contemporary continental philosophy know well the defenses Husserlians have offered of Husserl’s theory of inner time-consciousness against post-modernism’s deconstructive criticisms. As post-modernism gives way to Deleuzean post-structuralism, Deleuze’s Le bergsonisme has grown into the movement of Bergsonism. This movement, designed to present an alternative to phenomenology, challenges Husserlian phenomenology by criticizing the most “important… of all phenomenological problems.” Arguing that Husserl’s theory of time-consciousness detailed a linear succession of iterable instants in which the now internal to consciousness (...) receives prejudicial favor, Bergsonism concludes that Husserl derived the past from the present and cannot account for the sense of the past, which differs in kind from the present. Consequently, everything on Husserl’s account remains present and his theory cannot accommodate for time’s passage. In this paper, I renew the Husserlian defense of Husserl’s theory of time-consciousness in response to the recent movement of Deleuzean Bergsonism. Section one presents Bergsonism’s notion of the past in general and its critique of Husserl’s theory of time-consciousness. Section two presents a rejoinder to Bergsonism’s critique of Husserl, questioning (1) its understanding of the living-present as linearly extended, (2) its conflation of the living-present with Husserl’s early schema-apprehension interpretation, and (3) its failure to grasp Husserl’s revised understanding of primary memory as a result of (2). In conclusion, I suggest that Husserl’s theory of retention might articulate a notion of the past more consistent with Bergson than Bergsonism itself. (shrink)
This essay contests the standard historical comparison that links Husserl’s account of time-consciousness to the tradition by way of Book XI of Augustine’sConfessions. This comparison rests on the mistaken assumption that both thinkers attribute the soul’s distention and corresponding apprehension of time to memory. While true for Augustine and Husserl’s 1905 lectures on time, Husserl concluded after 1907 that these lectures advanced the flawed and counter-intuitive position that memory extends perception. I will trace the shortcomings of Augustine’s and Husserl’s conflation (...) of memory with perception. After developing Husserl’s maturely articulated distinction between memory and retention from 1911, I suggest chapters 10–14 of Aristotle’s Physics IV as a more apt anticipation of this second, more adequate half of the Husserlian story. A reconstruction of Aristotle’s definition of time as “the number of movement,” one that privileges the activity of “the mind pronouncing that the ‘nows’ are two,” intimates Husserl’s distinction between memory and retention. For Aristotle, the soul’s recognition of the ‘nows’ as two depends not on memory, but on the soul’s intentional activity of counting, itself dependent on the ability to, as Aristotle writes in his Metaphysics, “grasp mentally and [have] already grasped” at the same time. (shrink)
Although philosophers have characteristically taken the view that art is a vehicle of some universal meaning or truth, art historians emphasize the concrete, historical location of the individual work of art. Is aesthetics capable of sustaining these two approaches? Or, as Michael Kelly argues: Is art actually determined by its historical particularity? His book covers the views of four philosophers--Heidegger, Adorno, Derrida, and Danto--ultimately iconoclasts, despite their significant philosophical engagement with the arts.
"Examine[s] the history of Marxist philosophical issues in particular, dialectical materialism as developed by French Communist Party intellectuals... Remarkably clear, deeply researched, and well-written."- Political Science Quarterly.
Managerial reasoning is characteristic of a care-relationship ethics:1. If a corporation provides certain community values to corporate members not reducible to their self-interested economic or professional objectives; 2. If such values are generated by a division of labor based on interdependence, reciprocity and concern for another's self-realization; 3. If it's based on promoting an ethical corporate self independent of its economic value. Such an ethic is appropriate, given employees' tremendous personal contributions, the unique position of private industry to provide distinctive (...) resources without committing extensive social resources, and due to its potential for reducing managerial moral fragmentation and hypocrisy. (shrink)
The role of mechanistic evidence tends to be under-appreciated in current evidencebased medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available. Nevertheless, we argue that mechanistic evidence is central (...) to all the key tasks in the drug approval process: in drug discovery and development; assessing pharmaceutical quality; devising dosage regimens; assessing efficacy, harms, external validity, and cost-effectiveness; evaluating adherence; and extending product licences. We recommend that, when preparing for meetings in which any aspect of drug approval is to be discussed, mechanistic evidence should be systematically analysed and presented to the committee members alongside analyses of clinical studies. (shrink)
The purpose of this valuable book is to consider recent cultural trends in bioethics from a Catholic perspective. Bioethics is intended for a lay audience interested in understanding bioethical issues from a Catholic perspective.