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.

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)

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

_The_ _Routledge Companion to Philosophy of Medicine _is a comprehensive guide to topics in the fields of epistemology and metaphysics of medicine. It examines traditional topics such as the concept of disease, causality in medicine, the epistemology of the randomized controlled trial, the biopsychosocial model, explanation, clinical judgment and phenomenology of medicine and emerging topics, such as philosophy of epidemiology, measuring harms, the concept of disability, nursing perspectives, race and gender, the metaphysics of Chinese medicine, and narrative medicine. Each of (...) the 48 chapters is written especially for this volume and with a student audience in mind. For pedagogy and clarity, each chapter contains an extended example illustrating the ideas discussed. This text is intended for use as a reference for students in courses in philosophy of medicine and philosophy of science, and pairs well with _The_ _Routledge Companion to Bioethics_ for use in medical humanities and social science courses. (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 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)

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)

Epistemic diversity is widely approved of by social epistemologists. This paper asks, more specifi cally, how much epistemic diversity, and what kinds of epistemic diversity are normatively appropriate? Both laissez-faire and highly directive approaches to epistemic diversity are rejected in favor of the claim that diversity is a blunt epistemic tool. There are typically a number of diff erent options for adequate diversifi cation. The paper focuses on scientifi c domains, with particular attention to recent theories of smell.

Social scientists regularly make use of multivariate models to describe complex social phenomena. It is argued that this approach is useful for modelling the variety of cognitive and social factors contributing to scientific change, and superior to the integrated models of scientific change currently available. It is also argued that care needs to be taken in drawing normative conclusions: cognitive factors are not instrinsically more "rational" than social factors, nor is it likely that social factors, by some "invisible hand of (...) reason," generally work to produce scientific success. A multivariate model of the biasing factors within a scientific community at particular times is developed. This model, which is an example of work in social epistemology, yields normative conclusions. (shrink)

Quine claims to be "working from within" our conceptual scheme and proceeding scientifically. This description makes his views of interest to those who are skeptical of traditional metaphysical projects and to those with confidence in science. This study examines whether Quine is in fact starting within ordinary language and proceeding scientifically and, if not, how his views are to be best understood. I proceed by exploring some central doctrines in Quine's writing, most notably indeterminacy of translation, but also his views (...) on underdetermination of scientific theory, truth, reality and the dispensability of theory, and the nature of scientific method. In examining Quine's arguments for these doctrines, I find that they do not all issue from what we would ordinarily or scientifically say on the topics concerned. Instead, I find that most arise from an underlying view of the nature of language and knowledge, which I call natural empiricism. I argue that natural empiricism involves assumptions and dynamics of reasoning characteristic of metaphysical points of view, rather than of an ordinary or scientific stance. This is a result with consequences for a critical evaluation of Quine's views. ;I show that natural empiricism leads not only to the central doctrines in Quine's writing that I examine, but also to his general claim to be "working from within" our conceptual scheme and proceeding scientifically. I argue that there is a tension between natural empiricism and "working from within" that is the major tension in Quine's views, leading him to reach different conclusions on the same topic. Quine's views are unusual in that this tension is internal to natural empiricism; most metaphysical views, while they may conflict with the ordinary, do not also endorse it. Natural empiricism is also an unusual point of view in its thoroughgoing empiricism: I claim that it is an empiricist overreaction to the vestiges of rationalism in twentieth century logical empiricism. It shares with the views to which it reacts the need to ground language and knowledge, in a metaphysical sense. Thus Quine's position is particularly valuable for showing up the differences and common motivations in the analytic tradition. (shrink)

Philip Kitcher's The Advancement of Science sets out, programmatically, a new naturalistic view of science as a process of building consensus practices. Detailed historical case studies—centrally, the Darwinian revolutio—are intended to support this view. I argue that Kitcher's expositions in fact support a more conservative view, that I dub ‘Legend Naturalism’. Using four historical examples which increasingly challenge Kitcher's discussions, I show that neither Legend Naturalism, nor the less conservative programmatic view, gives an adequate account of scientific progress. I argue (...) for a naturalism that is more informed by psychology and a normative account that is both more social and less realist than the views articulated in The Advancement of Science. (shrink)

About ten years ago, I participated in a consensus process on migraine nomenclature. Participants used a modified Delphi technique to explore their views about what migraine is. Candidate concepts included an illness, disease, syndrome, condition, disorder, or susceptibility. Initially, there was a wide range of views about which concept best fits our concept of migraine. Migraine—in common with many psychiatric disorders—is poorly understood by neuroscience. On scientific grounds, participants thought that "susceptibility" and "syndrome" describes our current knowledge well. However, participants (...) were concerned that terms like "susceptibility" and "syndrome" could lead to migraine not... (shrink)

Anya Plutynski’s Explaining Cancer extends the insights of contemporary philosophy of biology to research on cancer and cancer treatment. Cancer is conceptualized as a complex process for which a pluralist theoretical approach is the most appropriate. This review essay explores implications for philosophy of science and cancer research.

Born to Rebel is an innovative and important work with much to say to philosophers of science, as well as historians and sociologists of science. Sulloway uses, successfully, quantitative statistical methods that others have despaired of using to analyze the complexities of historical change. In particular, he investigates scientific decision-making during scientific controversies with a multivariate analysis. The goal is to discern, precisely, the contribution of factors such as religious belief, social class, age, years of education, nationality, sex and personality.

In this paper I respond to the criticisms of Helen Longino, Alan Richardson, Naomi Oreskes and Sharyn Clough. There is discussion of the character of social knowledge, the goals of scientific inquiry, the connections between Social Empiricism and other approaches in science studies, productive and unproductive dissent, and the distinction between empirical and non-empirical decision vectors.

Born to Rebel is an innovative and important work with much to say to philosophers of science, as well as historians and sociologists of science. Sulloway uses, successfully, quantitative statistical methods that others have despaired of using to analyze the complexities of historical change. In particular, he investigates scientific decision-making during scientific controversies with a multivariate analysis. The goal is to discern, precisely, the contribution of factors such as religious belief, social class, age, years of education, nationality, sex and personality.

A development of Quine's views took place between the denial of analyticity (in "Two Dogmas") and the doctrine of indeterminacy (in Word and Object). Quine argues for the inscrutability of extensional as well as intensional content. The debate with Carnap in the mid-fifties pushes Quine to argue for full indeterminacy. Quine initially resists arguing for indeterminacy because the doctrine seems to lead to general skepticism, not just to skepticism about meanings. Quine draws on Tarski's work on truth to dispel the (...) skepticism, and only then argues for indeterminacy. This shows why Tarski's work is especially important for Quine. (shrink)

Because the idea of consensus in contemporary philosophy of science is typically seen as the locus of progress, rationality, and, often, truth, Mill’s views on the undesirability of consensus have been largely dismissed. The historical data, however, shows that there are many examples of scientific progress without consensus, thus refuting the notion that consensus in science has any special epistemic status for rationality, scientific progress (success), or truth. What needs to be developed instead is an epistemology of dissent. I suggest (...) that normative accounts of dissent be used as prototypes for theories of scientific rationality that can also be applied to episodes of consensus. Consensus in this case is to be treated as a special case of dissent, when the amount of dissent approaches zero. My main goal in this paper is to sketch how a normative account of dissent that aims to capture the idea of epistemic fairness can apply to situations of consensus. (shrink)

Naturalistic epistemologists frequently assume that their aim is to identify generalities (i.e. general laws) about the effectiveness of particular reasoning processes and methods. This paper argues that the search for this kind of generality fails. Work that has been done thus far to identify generalities (e.g. by Goldman, Kitcher and Thagard) overlooks both the complexity of reasoning and the relativity of assessments to particular contexts (domain, stage and goal of inquiry). Examples of human reasoning which show both complexity and contextuality (...) are given. The paper concludes with a discussion of the kind of multivariate model of reasoning that naturalistic epistemologists can use to evaluate processes and methods for specific domains. (shrink)

Since our visual perception of physical things essentially involves our identifying objects by their colours, any theory of visual perception must contain some account of the colours of things. The central problem with colour has to do with relating our normal, everyday colour perceptions to what science, i.e. physics, teaches us about physical objects and their qualities. Although we perceive colours as categorical surface properties of things, colour perceptions are explained by introducing physical properties like reflectance profiles or dispositions to (...) cause certain experiences in normal human perceivers. Hence, it seems as if colours as they are experienced by us have no place in the physical world, because they are fundamentally different from the properties which we ascribe to physical objects in scientific accounts of colour perceptions. This special issue on perspectives on colour perception presents new suggestions to solve to this major problem. (shrink)

: Harry Collins and Trevor Pinch's introductory text, The Golem: What Everyone Should Know About Science (1993), includes a controversy about the significance of pseudosexual behavior in the parthenogenetic whiptail lizard. Collins and Pinch, basing their account on the work of Greg Myers (1990), claim that "in this area of biology, experiments are seldom possible" and that the debate has "battled to an honorable draw." I argue that a closer look at the publications of the scientists involved shows that, at (...) least by the late 1980s, it was widely accepted that pseudosexual behavior is important for reproduction in these lizards. Moreover, a variety of experiments, as well as laboratory and field observations, proved decisive in this acceptance. (shrink)