BackgroundSocial cognition and competence are a key part of daily interactions and essential for satisfying relationships and well-being. Pediatric neurological and psychological conditions can affect social cognition and require assessment and remediation of social skills. To adequately approximate the complex and dynamic nature of real-world social interactions, innovative tools are needed. The aim of this study was to document the performance of adolescents on two versions of a serious video game presenting realistic, everyday, socio-moral conflicts, and to explore whether their (...) performance is associated with empathy or sense of presence, factors known to influence social cognition.MethodsParticipants first completed a pre-test measure of socio-moral reasoning based on three dilemmas from a previously validated computer task. Then, they either played an evaluative version or an adaptive version of a video game presenting nine social situations in which they made socio-moral decisions and provided justifications. In the evaluative version, participants’ audio justifications were recorded verbatim and coded manually to obtain a socio-moral reasoning maturity score. In the adaptive version, tailored feedback and social reinforcements were provided based on participant responses. An automatic coding algorithm developed using artificial intelligence was used to determine socio-moral maturity level in real-time and to provide a basis for the feedback and reinforcements in the game. All participants then completed a three-dilemma post-test assessment.ResultsThose who played the adaptive version showed improved SMR across the pre-test, in-game and post-test moral maturity scores, F = 9.81, pHF < 0.001, ϵ2 = 0.21, but those who played the Evaluative version did not. Socio-moral reasoning scores from both versions combined did not correlate with empathy or sense of presence during the game, though results neared significance. The study findings support preliminary validation of the game as a promising method for assessing and remediating social skills during adolescence. (shrink)

The COVID-19 pandemic represents the most significant global challenge in a generation. Based on extant data from previous pandemics, demographic, occupational, and psychological factors have been linked to distress and for some vulnerable members of society. COVID-19 has added to the layers of grief and distress of existing trauma. Evidence-based frameworks exist to guide our individual and collective response to reduce the trauma associated with the experience of a pandemic. Pandemic and post-pandemic measures to ameliorate impacts require a multi-disciplined approach, (...) central to which is community connectedness, resilience, and access to support. We advocate for the acceptance and broader application of Dadirri, a healing practice held by the Ngan'gikurunggurr and Ngen'giwumirri Aboriginal people of the Daly River region in the Northern Territory, Australia. This modality engages therapeutic phases that are comparable with other practiced trauma therapies. The demonstrated therapeutic outcomes from Dadirri can be attained through an individualistic or in a relational engagement context. This practice is accessible to all ages, is non-specific to gender and is suitable for people constrained in their mobility or limited by resources, pertinent in pandemic affected settings. (shrink)

Infinite time register machines (ITRMs) are register machines which act on natural numbers and which are allowed to run for arbitrarily many ordinal steps. Successor steps are determined by standard register machine commands. At limit times register contents are defined by appropriate limit operations. In this paper, we examine the ITRMs introduced by the third and fourth author (Koepke and Miller in Logic and Theory of Algorithms LNCS, pp. 306–315, 2008), where a register content at a limit time is set (...) to the lim inf of previous register contents if that limit is finite; otherwise the register is reset to 0. The theory of these machines has several similarities to the infinite time Turing machines (ITTMs) of Hamkins and Lewis. The machines can decide all ${\Pi^1_1}$ sets, yet are strictly weaker than ITTMs. As in the ITTM situation, we introduce a notion of ITRM-clockable ordinals corresponding to the running times of computations. These form a transitive initial segment of the ordinals. Furthermore we prove a Lost Melody theorem: there is a real r such that there is a program P that halts on the empty input for all oracle contents and outputs 1 iff the oracle number is r, but no program can decide for every natural number n whether or not ${n \in r}$ with the empty oracle. In an earlier paper, the third author considered another type of machines where registers were not reset at infinite lim inf’s and he called them infinite time register machines. Because the resetting machines correspond much better to ITTMs we hold that in future the resetting register machines should be called ITRMs. (shrink)

BackgroundKnowledge development depends on an unbiased representation of the available evidence. Selective citation may distort this representation. Recently, some controversy emerged regarding the possible impact of swimming on childhood asthma, raising the question about the role of selective citation in this field. Our objective was to assess the occurrence and determinants of selective citation in scientific publications on the relationship between swimming in chlorinated pools and childhood asthma.MethodsWe identified scientific journal articles on this relationship via a systematic literature search. The (...) following factors were taken into account: study outcome (authors’ conclusion, data-based conclusion), other content-related article characteristics (article type, sample size, research quality, specificity), content-unrelated article characteristics (language, publication title, funding source, number of authors, number of affiliations, number of references, journal impact factor), author characteristics (gender, country, affiliation), and citation characteristics (time to citation, authority, self-citation). To assess the impact of these factors on citation, we performed a series of univariate and adjusted random-effects logistic regressions, with potential citation path as unit of analysis.ResultsThirty-six articles were identified in this network, consisting of 570 potential citation paths of which 191 (34%) were realized. There was strong evidence that articles with at least one author in common, cited each other more often than articles that had no common authors (odds ratio (OR) 5.2, 95% confidence interval (CI) 3.1–8.8). Similarly, the chance of being cited was higher for articles that were empirical rather than narrative (OR 4.2, CI 2.6–6.7), that reported a large sample size (OR 5.8, CI 2.9–11.6), and that were written by authors with a high authority within the network (OR 4.1, CI 2.1–8.0). Further, there was some evidence for citation bias: articles that confirmed the relation between swimming and asthma were cited more often (OR 1.8, CI 1.1–2.9), but this finding was not robust.ConclusionsThere is clear evidence of selective citation in this research field, but the evidence for citation bias is not very strong. (shrink)

According to the Spatial Quantity Association of Response Codes (SQUARC), people hold a mental association between horizontal position and quantity (lower quantities left, higher quantities right). While a large body of research has explored this effect for response speed and judgment accuracy, the affective downstream consequences of the SQUARC remain unexplored. Aiming to address this gap, the present two experiments (pre-registered, total N = 521) investigated whether stimulus arrangements that are compatible with the SQUARC for luminance are affectively preferred to (...) stimulus arrangements that are incompatible. SQUARC-compatible square arrangements (dark-left, bright-right) were preferred over SQUARC-incompatible square arrangements (dark-right, bright-left). The preference for SQUARC compatibility was not moderated by the horizontal orientation of the response scale. Our results confirm the direction of the spatial-luminance association and provide initial support that the cognitive processing of SQUARC compatibility is hedonically marked and appears sufficient to impact affective evaluations. (shrink)

Apresentaçáo da traduçáo do artigo de Paul Thagard.

As a continuation of the previous paper,Praying for a Miracle – Negative or Positive Impacts on Health Care, published in this research topic, this second paper aims at delving deeper into the same theme, but now from a simultaneously practical and conceptual approach. With that in mind, we revisit three theoretical models based on evidence, through which we can understand the role of a miracle in hospital settings and assess its impact in health contexts. For each of the models described, (...) we seek to illustrate the possible outcomes of belief in miracles as a modality of religious coping in situations of stress and suffering experienced by patients and caregivers in the face of gloomy diagnoses on coming across the limits of medicine to revert certain illnesses (e.g., child cancer) or biological conditions (e.g., fetal malformation). We posit that the judgment about how such a mechanism is healthy or not for each of the people involved (patient, caregiver, and/or health professional) depends on the modulation between the conception of the miracle adopted by the patient and/or caregiver and the concrete outcomes of the way of responding to the situations that accompany the gravity of the illness or condition. To better understand this process of psychological modulation that accompanies belief in miracles, we revisit the concepts of spirituality, religiosity, and religion, pointing out the connections and distinctions between them from a phenomenological perspective. We then present a conceptual model that takes these connections and distinctions into consideration to foster an understanding of miracles, their relations with the diversity of experiences of people who meet in hospital settings (patients, caregivers, and health professionals), and their respective impacts on healthcare. (shrink)

The neural basis of developmental changes in transitive reasoning in parietal regions was examined, using voxel-based morphometry. Young adolescents and adults performed a transitive reasoning task, subsequent to undergoing anatomical magnetic resonance imaging brain scans. Behaviorally, adults reasoned more accurately than did the young adolescents. Neural results showed less grey matter density in superior parietal cortex in the adults than in the young adolescents, possibly due to a developmental period of synaptic pruning; improved performance in the reasoning task was negatively (...) correlated with grey matter density in superior parietal cortex in the adolescents, but not in the adult group; and the latter results were driven by the more difficult trials, requiring greater spatial manipulation. Taken together, the results support the idea that during development, regions in superior parietal cortex are fine-tuned, to support more robust spatial manipulation, resulting in gre... (shrink)

Este artigo investiga as mudanças conceituais revolucionárias que ocorreram quando a teoria do flogisto de Stahl foi substituída pela teoria do oxigênio de Lavoisier. Utilizando técnicas extraídas da inteligência artificial, o artigo descreve os estágios cruciais no desenvolvimento conceitual de Lavoisier, de 1772 até 1789. Em seguida, é esboçada uma teoria computacional da mudança conceitual de modo a explicar a descoberta de Lavoisier da teoria do oxigênio e a substituiçáo da teoria do flogisto. Este artigo é uma traduçáo de “The (...) Conceptual Structure of The Chemical Revolution”, publicado originalmente em Philosophy of Science , número 57, p. 183-209, 1990. Todos os direitos do artigo pertencem à revista Philosophy of Science , editada pela University of Chicago Press. O copyright do artigo original é de 1990, da Philosophy of Science Association. Os tradutores agradecem a Paul Thagard e a Philosophy of Science a permissáo para esta traduçáo. [NT.]. (shrink)

Human Action: a Comprehensive Proposal for Interdisciplinary Dialogue on Personality The need to categorize the personality is recurrent in philosophical, theological and, especially, psychological studies. However, the lack of dialogue between the different disciplines gives rise to analyzes that seem to divide human reality into 'parts', often incompatible with each other. In view of this problem, this article proposes the integral analysis of human action, seeking a psychological parameterization that is more adjusted to the complexity of the personality. Starting from (...) the integral vision of the action, the human behavioral and mental aspects commonly studied are seen as insufficient and the horizon is broadened with the reference to interiority. It is intended to achieve a more accurate vision of the complexity of human action. Interiority, parameterized as personal identity, relational intention, and existential positioning, calls for a renewed and related understanding of psychology, philosophy, and theology. (shrink)

In this paper, I begin by defending permissivism: the claim that, sometimes, there is more than one way to rationally respond to a given body of evidence. Then I argue that, if we accept permissivism, certain worries that arise as a result of learning that our beliefs were caused by the communities we grew up in, the schools we went to, or other irrelevant influences dissipate. The basic strategy is as follows: First, I try to pinpoint what makes irrelevant influences (...) worrying and I come up with two candidate principles. I then argue that one principle should be rejected because it is inconsistent with permissivism. The principle we should accept implies that it is sometimes rational to maintain our beliefs, even upon learning that they were caused by irrelevant influences. (shrink)

The question of whether it is ever permissible to believe on insufficient evidence has once again become a live question. Greater attention is now being paid to practical dimensions of belief, namely issues related to epistemic virtue, doxastic responsibility, and voluntarism. In this book, McCormick argues that the standards used to evaluate beliefs are not isolated from other evaluative domains. The ultimate criteria for assessing beliefs are the same as those for assessing action because beliefs and actions are both products (...) of agency. Two important implications of this thesis, both of which deviate from the dominant view in contemporary philosophy, are 1) it can be permissible to believe for non-evidential reasons, and 2) we have a robust control over many of our beliefs, a control sufficient to ground attributions of responsibility for belief. (shrink)

For the last forty years, two claims have been at the core of disputes about scientific change: that scientists reason rationally and that science is progressive. For most of this time discussions were polarized between philosophers, who defended traditional Enlightenment ideas about rationality and progress, and sociologists, who espoused relativism and constructivism. Recently, creative new ideas going beyond the polarized positions have come from the history of science, feminist criticism of science, psychology of science, and anthropology of science. Addressing the (...) traditional arguments as well as building on these new ideas, Miriam Solomon constructs a new epistemology of science. After discussions of the nature of empirical success and its relation to truth, Solomon offers a new, social account of scientific rationality. She shows that the pursuit of empirical success and truth can be consistent with both dissent and consensus, and that the distinction between dissent and consensus is of little epistemic significance. In building this social epistemology of science, she shows that scientific communities are not merely the locus of distributed expert knowledge and a resource for criticism but also the site of distributed decision making. Throughout, she illustrates her ideas with case studies from late-nineteenth- and twentieth-century physical and life sciences. Replacing the traditional focus on methods and heuristics to be applied by individual scientists, Solomon emphasizes science funding, administration, and policy. One of her goals is to have a positive influence on scientific decision making through practical social recommendations. (shrink)

Economic and social activities are undergoing radical changes, which can be labelled as 'knowledge economy and/or society'. In this sense, intellectual capital (IC), or knowledge assets, as the fourth factor of production, is replacing the other ones-job, land and capital. This article tries to offer the origins and nature of the firm's IC that can be labelled as 'An Intellectual Capital-Based View of the Firm Competition'. This framework tries to highlight the strategic role of different intangible assets like talented and (...) committed workers, cultural values, or long-term relationships among the firm and its stakeholders-customers, allies, suppliers and society in general - in gaining and sustaining competitive advantages, being the management of IC a key issue in the management agenda. (shrink)

How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

This paper is about the connection between rationality and accuracy. I show that one natural picture about how rationality and accuracy are connected emerges if we assume that rational agents are rationally omniscient. I then develop an alternative picture that allows us to relax this assumption, in order to accommodate certain views about higher order evidence.

A new, social epistemology of science that addresses practical as well as theoretical concerns.

In recent years, permissivism—the claim that a body of evidence can rationalize more than one response—has enjoyed somewhat of a revival. But it is once again being threatened, this time by a host of new and interesting arguments that, at their core, are challenging the permissivist to explain why rationality matters. A version of the challenge that I am especially interested in is this: if permissivism is true, why should we expect the rational credences to be more accurate than the (...) irrational ones? My aim is to turn this challenge on its head and argue that, actually, those who deny permissivism will have a harder time responding to such a challenge than those who accept it. (shrink)

The aim of this paper is to apply the accuracy based approach to epistemology to the case of higher order evidence: evidence that bears on the rationality of one's beliefs. I proceed in two stages. First, I show that the accuracy based framework that is standardly used to motivate rational requirements supports steadfastness—a position according to which higher order evidence should have no impact on one's doxastic attitudes towards first order propositions. The argument for this will require a generalization of (...) an important result by Greaves and Wallace for the claim that conditionalization maximizes expected accuracy. The generalization I provide will, among other things, allow us to apply the result to cases of self-locating evidence. In the second stage, I develop an alternative framework. Very roughly, what distinguishes the traditional approach from the alternative one is that, on the traditional picture, we're interested in evaluating the expected accuracy of conforming to an update procedure. On the alternative picture that I develop, instead of considering how good an update procedure is as a plan to conform to, we consider how good it is as a plan to make. I show how, given the use of strictly proper scoring rules, the alternative picture vindicates calibrationism: a view according to which higher order evidence should have a significant impact on our beliefs. I conclude with some thoughts about why higher order evidence poses a serious challenge for standard ways of thinking about rationality. (shrink)

A defense of imprecise credences (and other imprecise doxastic attitudes).

The aim of this paper is to describe a problem for calibrationism: a view about higher order evidence according to which one's credences should be calibrated to one's expected degree of reliability. Calibrationism is attractive, in part, because it explains our intuitive judgments, and provides a strong motivation for certain theories about higher order evidence and peer disagreement. However, I will argue that calibrationism faces a dilemma: There are two versions of the view one might adopt. The first version, I (...) argue, has the implausible consequence that, in a wide range of cases, calibrationism is the only constraint on rational belief. The second version, in addition to having some puzzling consequences, is unmotivated. At the end of the paper I sketch a possible solution. (shrink)

For this Clarendon Paperback, Dr Griffin has written a new Postscript to bring the original book fully up to date. She discusses further important and controversial questions of fact or interpretation in the light of the scholarship of the intervening years and provides additional argument where necessary. The connection between Seneca's prose works and his career as a first-century Roman statesman is problematic. Although he writes in the first person, he tells us little of his external life or of the (...) people and events that formed its setting. Miriam Griffin addresses the problem by first reconstructing Seneca's career using only outside sources and his de Clementia and Apocolocyntosis, whose political purposes are undisputed. In the second part of the book she studies Seneca's treatment of subjects of political significance, including his views on slavery, provincial policy, wealth, and suicide. On the whole, the word of the philosopher is found to illuminate the work of the statesman, but notable exceptions emerge, and the links that are revealed vary from theme to theme and rarely accord with traditional autobiographical interpretations of Seneca's works. (shrink)

It has been claimed that, in response to certain kinds of evidence, agents ought to adopt imprecise credences: doxastic states that are represented by sets of credence functions rather than single ones. In this paper I argue that, given some plausible constraints on accuracy measures, accuracy-centered epistemologists must reject the requirement to adopt imprecise credences. I then show that even the claim that imprecise credences are permitted is problematic for accuracy-centered epistemology. It follows that if imprecise credal states are permitted (...) or required in the cases that their defenders appeal to, then the requirements of rationality can outstrip what would be warranted by an interest in accuracy. (shrink)

Greaves and Wallace argue that conditionalization maximizes expected accuracy. In this paper I show that their result only applies to a restricted range of cases. I then show that the update procedure that maximizes expected accuracy in general is one in which, upon learning P, we conditionalize, not on P, but on the proposition that we learned P. After proving this result, I provide further generalizations and show that much of the accuracy-first epistemology program is committed to KK-like iteration principles (...) and to the existence of a class of propositions that rational agents will be certain of if and only if they are true. (shrink)

Abstract: This paper defends a constraint that any satisfactory decision theory must satisfy. I show how this constraint is violated by all of the decision theories that have been endorsed in the literature that are designed to deal with cases in which opinions or values are represented by a set of functions rather than a single one. Such a decision theory is necessary to account for the existence of what Ruth Chang has called “parity” (as well as for cases in (...) which agents have incomplete preferences or imprecise credences). The problem with the all of the decision theories that have been defended to account for parity is that they are committed to a claim I call unanimity: when all of the functions in the set agree that an agent ought to do A, then an agent ought to do A. A decision theory committed to unanimity violates the constraint I defend in this paper. Thus, if parity exists, a new approach to decision theory is necessary. (shrink)

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students’ experience of an ethical problem involving nursing practice? and (2) What is nursing students’ experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems consisted of the nursing students’ experience (...) of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice. (shrink)

The work of Tversky, Kahneman and others suggests that people often make use of cognitive heuristics such as availability, salience and representativeness in their reasoning and decision making. Through use of a historical example--the recent plate tectonics revolution in geology--I argue that such heuristics play a crucial role in scientific decision making also. I suggest how these heuristics are to be considered, along with noncognitive factors (such as motivation and social structures) when drawing historical and epistemological conclusions. The normative perspective (...) is community-wide, contextual, and instrumental. (shrink)

My main aim is to argue that most conceptions of doxastic agency do not respond to the skeptic’s challenge. I begin by considering some reasons for thinking that we are not doxastic agents. I then turn to a discussion of those who try to make sense of doxastic agency by appeal to belief’s reasons-responsive nature. What they end up calling agency is not robust enough to satisfy the challenge posed by the skeptics. To satisfy the skeptic, one needs to make (...) sense of the possibility of believing for nonevidential reasons. While this has been seen as an untenable view for both skeptics and anti-skeptics, I conclude by suggesting it is a position that has been too hastily dismissed. (shrink)

I investigate what we mean when we hold people responsible for beliefs. I begin by outlining a puzzle concerning our ordinary judgments about beliefs and briefly survey and critique some common responses to the puzzle. I then present my response where I argue a sense needs to be articulated in which we do have a kind of control over our beliefs if our practice of attributing responsibility for beliefs is appropriate. In developing this notion of doxastic control, I draw from (...) John Fischer's discussions of “guidance control”. A central feature of this kind of control is the idea of “ownership”. I argue that we can own our beliefs and that we expect each other to do so. We take responsibility for our beliefs and taking responsibility includes taking control of them. I end by considering objections to my view as well as some implications of it. (shrink)

The Queen's College, Oxford, UK In his article `Facts and Principles', G.A. Cohen attempts to refute constructivist approaches to justification by showing that, contrary to what their proponents claim, fundamental normative principles are fact- in sensitive. We argue that Cohen's `fact-insensitivity thesis' does not provide a successful refutation of constructivism because it pertains to an area of meta-ethics which differs from the one tackled by constructivists. While Cohen's thesis concerns the logical structure of normative principles, constructivists ask how normative principles (...) should be justified . In particular, their claim that justified fundamental normative principles are fact-sensitive follows from a commitment to agnosticism about the existence of objective moral facts. We therefore conclude that, in order to refute constructivism, Cohen would have to address questions of justification, and take a stand on those long-standing meta-ethical debates about the ontological status of moral notions (for example, realism versus anti-realism) with respect to which he himself wants to remain agnostic. Key Words: John Rawls • normative justification • realism versus anti-realism • methodological versus substantive principles. (shrink)

Had we grown up elsewhere or been educated differently, our view of the world would likely be radically different. What to make of this? This paper takes an accuracy-centered first-personal approach to the question of how to respond to the arbitrary nature in which many of our beliefs are formed. I show how considerations of accuracy motivate different responses to this sort of information depending on the type of attitude we take towards the belief in question upon subjecting the belief (...) to doubt. (shrink)

It seems like we care about at least two features of our credence function: gradational-accuracy and verisimilitude. Accuracy-first epistemology requires that we care about one feature of our credence function: gradational-accuracy. So if you want to be a verisimilitude-valuing accuracy-firster, you must be able to think of the value of verisimilitude as somehow built into the value of gradational-accuracy. Can this be done? In a recent article, Oddie has argued that it cannot, at least if we want the accuracy measure (...) to be proper. I argue that it can. 1Introduction2Some Nuts and Bolts3First Attempts4Oddie’s Constraint5The Good5.1Proximity over the disagreement metric 5.2Proximity over the magnitude metric 6The Bad and the Ugly 7Some More Good: The Role of Evenness of Distribution 8Some More Bad: Which Propositions to Privilege? 9Concluding Thoughts: Accuracy and Practical Value. (shrink)

Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of (...) non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest. (shrink)

Trust in the practice of rational deliberation is widespread and largely unquestioned. This paper uses recent work from business contexts to challenge the view that rational deliberation in a group improves decisions. Pressure to reach consensus can, in fact, lead to phenomena such as groupthink and to suppression of relevant data. Aggregation of individual decisions, rather than deliberation to a consensus, surprisingly, can produce better decisions than those of either group deliberation or individual expert judgment. I argue that dissent is (...) epistemically valuable, not because of the discussion it can provoke (Mill's and Longino's view about the benefit of dissent), but because dissenting positions often are associated with particular data or insights that would be lost in consensus formation. Social epistemologists can usefully pay attention to various methods of aggregation of individual opinion for their effectiveness at realizing epistemic goals. (shrink)

The aim of this essay is to argue that, if a robust form of moral realism is true, then moral vagueness is ontic vagueness. The argument is by elimination: I show that neither semantic nor epistemic approaches to moral vagueness are satisfactory.

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)