This paper assesses the epistemic challenges of giving nutrition advice to elite athletes in light of recent philosophical discussion concerning evidence-based practice. Our trust in experts largely depends on the assumption that their advice is based on reliable evidence. In many fields, the evaluation of the reliability of evidence is made on the basis of standards that originate from evidence-based medicine. I show that at the Olympic or professional level, implementing nutritional plans in real-world competitions (...) requires contextualization of knowledge in a way that contravenes the tenets of evidence-based thinking. Nutrition experts need to be able to combine and apply evidence from multiple sources, including the previous successes and failures of particular athletes. I argue that in this sense, the practice of elite sport nutrition embodies casuistic reasoning. (shrink)

At the heart of the debate between social role theorists and evolutionary psychologists is whether natural selection has designed the minds of the sexes differently to some interesting extent. In this commentary I describe the standards of evidence for both the positive and negative claims. In my opinion, Archer has met the standard for designed sex differences in intrasexual conflict.

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients (...) prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. (shrink)

An astonishing volume and diversity of evidence is available for many hypotheses in the biomedical and social sciences. Some of this evidence—usually from randomized controlled trials (RCTs)—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not RCTs are the ‘gold-standard’ of evidence, it is usually meta-analysis which is considered the best source of evidence: meta-analysis is thought by many to be the platinum standard of evidence. However, I argue that meta-analysis falls far short (...) of that standard. Different meta-analyses of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for intersubjective assessments of hypotheses because numerous decisions must be made when performing a meta-analysis which allow wide latitude for subjective idiosyncrasies to influence its outcome. I end by suggesting that an older tradition of evidence in medicine—the plurality of reasoning strategies appealed to by the epidemiologist Sir Bradford Hill—is a superior strategy for assessing a large volume and diversity of evidence. (shrink)

MacCann, Matthews, and Roberts (2012) and Mayer, Salovey, and Caruso (2012) have offered responses to my evaluation of the validity of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) as a measure of emotional intelligence. MacCann et al. argue that my standards for validity evidence are unrealistically high, but their argument mistakenly supposes that the concept of measurement is somehow relative, rather than absolute. Mayer et al. offer valuable clarifications regarding their emotional intelligence (EI) model, and some new evidence (...) of its correlates. However, the new evidence is not persuasive, and I think that they have largely missed the point of my call for a stronger focus on causal explanations of test performance. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against (...) placebo. But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

We motivate the possibility of using notions and methods derived from quantum physics, and more specifically from the research field known as ‘quantum cognition’, to optimally model different situations in the field of medicine, its decision-making processes and ensuing practices, particularly in relation to chronic and rare diseases. This also as a way to devise alternative approaches to the generally adopted double-blind gold standard.

We motivate the possibility of using notions and methods derived from quantum physics, and more specifically from the research field known as ‘quantum cognition’, to optimally model different situations in the field of medicine, its decision-making processes and ensuing practices, particularly in relation to chronic and rare diseases. This also as a way to devise alternative approaches to the generally adopted double-blind gold standard.

The Article addresses three main questions. First: Why do some scholars and decision-makers take evidence assessment criteria as standards of proof and vice versa? The answer comes from the fact that some legal systems are more concerned with assessment criteria and others with standards; therefore jurists educated in different contexts tend to emphasize what they are more familiar with, and to assimilate to it what they are less familiar with. Second: Why do systems differ in those respects? (...) Here the answer stems from the historical, institutional and procedural differences that explain why some systems are more concerned with assessment criteria and others with standards of proof. And third, assuming that both criteria and standards are necessary to legal decision-making about facts: How can a system work if it neglects one of these things? Here the Article argues that there is a functional connection between criteria and standards. The functional connection account is distinguished from a functional equivalence account, and some systems and jurisdictions are referred to in greater detail to support the functional connection claim. (shrink)

Ferdinand Schoeman (1986) attempts to refute six arguments that I gave in The Probable and the Provable (1977, pp. 49-120) for not analyzing the standards of forensic proof in terms of any concept of probability that conforms to the familiar principles of the mathematical calculus of chance. But he evidently does not appreciate the strength of the case for rejecting the validity of any such analysis. In the course of discussing his criticisms, I shall add a seventh argument to (...) fortify my position, though I concede that the second of my original arguments has to be discarded. (shrink)

Many legal disputes turn on scientific, especially statistical, evidence. Traditionally scientists have accepted only that statistical evidence which satisfies a 95 percent (or 99 percent) rule — that is, only evidence which has less than five percent (or one percent) probability of resulting from chance.The rationale for this rule is the reluctance of scientists to accept anything less than the best-supported new knowledge. The rule reflects the internal needs of scientific practice. However, when uncritically adopted as a (...) rule for admitting legal evidence, the seemingly innocuous 95 percent rule distorts the balance of interests historically protected by the legal system. In particular, plaintiffs in toxic tort and employment discrimination suits are effectively held to a heavier burden of proof in showing that their injuries were more probably than not caused by the defendant's actions. The result is that too many victims of toxic torts or employment discrimination cannot win legal redress for their injuries. (shrink)

In discussions of standards of proof, a familiar perspective often emerges. According to what we call specificationism, standards of proof are legal rules that specify the quantum of evidence required to determine that a litigant’s claim has been proven. In so doing, they allocate the risk of error among litigants (and potential litigants), minimizing the risk of certain types of error. Specificationism is meant as a description of the way the rules actually function. We argue, however, that (...) its claims are either mistaken or at a minimum deeply misleading, especially when it comes to standard of proof rules (SPRs) that contain indeterminate formulas, as is typical. As against specificationism, we argue that SPRs are best understood as rules that confer competence to decide whether a given standard has been met—according to whatever vague or inchoate interpretation (if any) of the rule in question triers of fact implicitly or explicitly employ. We call this the competence-norm approach. (shrink)

This paper adds evidence structure to standard models of belief, in the form of families of sets of worlds. We show how these more fine-grained models support natural actions of “evidence management”, ranging from update with external new information to internal rearrangement. We show how this perspective leads to new richer languages for existing neighborhood semantics for modal logic. Our main results are relative completeness theorems for the resulting dynamic logic of evidence.

The essays in Powerful Arguments reconstruct the standards of validity underlying argumentative practices in a wide array of late imperial Chinese discourses, from the Song through the Qing dynasties. The fourteen case studies analyze concrete arguments defended or contested in areas ranging from historiography, philosophy, law, and religion to natural studies, literature, and the civil examination system. By examining uses of evidence, habits of inference, and the criteria by which some arguments were judged to be more persuasive than (...) others, the contributions recreate distinct cultures of reasoning. Together, they lay the foundations for a history of argumentative practice in one of the richest scholarly traditions outside of Europe and add a chapter to the as yet elusive global history of rationality. (shrink)

The COVID-19 pandemic poses extraordinary public health challenges. In order to respond to such challenges, most democracies have relied on so-called ‘evidence-based’ policies, which supposedly devolve to science the burden of their justification. However, the biomedical sciences can only provide a theory-laden evidential basis, while reliable statistical data for policy support is often scarce. Therefore, scientific evidence alone cannot legitimise COVID-19 public health policies, which are ultimately based on political decisions. Given this inevitable input on policy-making, the risk (...) of arbitrariness is ubiquitous and democratic scrutiny becomes essential to counter it. During the COVID-19 pandemic, the standards of scientific and democratic scrutiny have been, as a matter of fact, substantially lowered. This erosion potentially damages democracy. (shrink)

It is argued by Lie et al in the current issue of the Journal of Medical Ethics that an international consensus opinion has formed on the issue of standards of care in clinical trials undertaken in developing countries. This opinion, so they argue, rejects the Declaration of Helsinki’s traditional view on this matter. They propose furthermore that the Declaration of Helsinki has lost its moral authority in the controversy in research ethics. Although the latter conclusion is supported by this (...) author, it will be demonstrated in this paper that there is not such a thing as an international consensus opinion, and that the authorities used by Lie et al as evidence in support of their claim should not be relied upon as authorities or final arbiters in this debate. Furthermore, it will be shown that arguments advanced substantively to show that lower standards of care are ethically acceptable in the developing world, conflate scientific with economic reasons, and ultimately fail to bolster the case they are designed to support. (shrink)

Dating back to the 1930s, President Franklin D. Roosevelt argued that workers were entitled to a wage that allowed them to enjoy a decent standard of living—a conviction that led the president to propose the first federally-mandated minimum wage. Mr. Roosevelt’s proposal was met with highly partisan resistance in congress and the courts—reactions not different in kind from the highly partisan resistance former President Obama experienced in his proposal to increase the federal minimum wage from its current level of $7.25 (...) per hour. Reflecting President Roosevelt’s convictions, it is clear that many low wage workers today are not, and cannot, enjoying a decent standard of living at current minimum wage levels. Further, many of the economic arguments raised in opposition to increasing the minimum wage have been thoroughly discredited: empirical evidence suggests that increased minimum wages would not lead to dramatic spikes in unemployment, massive substitutions of capital for labor, business closings, and significantly increased consumer prices. However, as compelling as arguments for increasing the minimum wage may be, the reality is that this may not be sufficient to alleviate the plight of low income workers, particularly given the political nature of minimum wage adjustments. Indeed, it may be time to shift the national focus away from the minimum wage to an emphasis on viable living wage legislation, a proposition consistent with the social justice perspective of contemporary ethicists. (shrink)

Law wrangles with setting and applying standards for the practice of medicine in many different arenas. One of the most prominent is medical malpractice litigation in which the trial process examines a physician's performance and measures it against the standard of care. The profession's prevailing custom, with some substantial tolerance for “respectable minority” views, has been the gold standard for scrutinizing physician practice and treatment decisions in the malpractice context. Using the profession's custom as the measure against which a (...) physician's performance is judged defers to the expertise of medicine. Deference to the medical profession is attractive as a tool for reining in law. Reliance on customary practice is criticized, however, for driving physicians to the relative safety of the middle of the herd. Creating such a strong incentive for compliance with customary practice can dampen medical innovation and the diffusion of new clinical knowledge. The safety of the herd can also deprive individual patients of the best care in their particular circumstances.Several current trends are strengthening claims that professional practice patterns are an inappropriate tool for distinguishing between high‐quality and substandard care. In particular, advocacy for evidence‐based medicine aggressively asserts that the traditional way of making medical treatment decisions is largely untethered from scientific method or data, rendering professional judgment, even in the aggregate, suspect. (shrink)

Could it be right to convict and punish defendants using only statistical evidence? In this paper, I argue that it is not and explain why it would be wrong. This is difficult to do because there is a powerful argument for thinking that we should convict and punish defendants using statistical evidence. It looks as if the relevant cases are cases of decision under risk and it seems we know what we should do in such cases (i.e., maximize (...) expected value). Given some standard assumptions about the values at stake, the case for convicting and punishing using statistical evidence seems solid. In trying to show where this argument goes wrong, I shall argue (against Lockeans, reliabilists, and others) that beliefs supported only by statistical evidence are epistemically defective and (against Enoch, Fisher, and Spectre) that these epistemic considerations should matter to the law. To solve the puzzle about the role of statistical evidence in the law, we need to revise some commonly held assumptions about epistemic value and defend the relevance of epistemology to this practical question. (shrink)

Teaching of responsible conduct of research is largely predicated on the assumption that there are accepted standards of conduct that can be taught. However there is little evidence of consensus in the scientific community about such standards, at least for the practices of authorship, collaboration, and data management. To assess whether such differences in standards are based on disciplinary differences, a survey, described previously, addressing standards, practices, and perceptions about teaching and learning was distributed in (...) November 2010 to US faculty from 50 graduate programs for the biomedical disciplines of microbiology, neuroscience, nursing, and psychology. Despite evidence of statistically significant differences across the four disciplines, actual differences were quite small. Stricter measures of effect size indicated practically significant disciplinary differences for fewer than 10 % of the questions. This suggests that the variation in individual standards of practice within each discipline is at least as great as variation due to differences among disciplines. Therefore, the need for discipline-specific training may not be as important as sometimes thought. (shrink)

This study compares findings from the author's survey of 310 French newspaper journalists in France with a simultaneous survey done in the United States. In both studies, journalists replied to the same battery of questions about ethical standards in reporting. Results provide evidence of shared values among French journalists and, to a much lesser extent, between French and U.S. journalists. The highest agreement was found in support of keeping a promise of source confidentiality. French results further indicated support (...) for the notion that journalists differentiate between the justification of active and passive deception. The study calls for polling of nonjournalists in similar future studies to aid in sorting out cultural from occupational differences and similarities. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral (...) medicine aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

According to a common conception of legal proof, satisfying a legal burden requires establishing a claim to a numerical threshold. Beyond reasonable doubt, for example, is often glossed as 90% or 95% likelihood given the evidence. Preponderance of evidence is interpreted as meaning at least 50% likelihood given the evidence. In light of problems with the common conception, I propose a new ‘relevant alternatives’ framework for legal standards of proof. Relevant alternative accounts of knowledge state that (...) a person knows a proposition when their evidence rules out all relevant error possibilities. I adapt this framework to model three legal standards of proof—the preponderance of evidence, clear and convincing evidence, and beyond reasonable doubt standards. I describe virtues of this framework. I argue that, by eschewing numerical thresholds, the relevant alternatives framework avoids problems inherent to rival models. I conclude by articulating aspects of legal normativity and practice illuminated by the relevant alternatives framework. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral (...) medicine aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standards of Music Education and the Easily Administered Child/Citizen: The Alchemy of Pedagogy and Social Inclusion/Exclusion Thomas S. Popkewitz and Ruth Gustafson University of Wisconsin-Madison Educational standards are forsome a corrective device to promote the twin goals of excellence and equity by making explicit the performance outcomes ofschooling. For others, performance standards do not do what they say and install the wrong goals for teaching. But (...) various sides in the debate assume that school subjects teach the subjects and what is needed are more effective and efficient classroom practices. Our approach is different. We consider the standards of school subjects as related to the conditions of state governing. School subjects inscribe principles that administer the conduct ofthe child who is to grow into the "reasonable citizen." The Standards Movement is more than what is publicly discussed. Pedagogy embodies particular ways ofthinking or a system ofreason in which pedagogy orders who we are, who we should become, and who are not qualifiedto become that "we." If we think of modern schooling as an inscription device in the fonning of the citizen through the development ofthe child, the crux of the debate is not whether to have standards. It is how particular standards are inscribed through pedagogicalpractices. Ifwe treat school subjects as analogous to a uniform system of taxes, the developmentofuniformmeasurements, andurban planning in the modem state, our concern is with the boundaries created about the rules and standards of reason and the reasonable person. Pedagogygoverns inadoublesense: schoolmusic embodies representations that constitute the objects that children act on as real, and it generates principles to orderand patrol the borders that qualify and disqualify individuals for participation. The standards that govern music education can be thought about as an alchemy.1 The field of music is transported and translated into school subjects andpedagogical content. As the sorcerer ofthe middle ages sought to turn lead into gold, a specializedpedagogyplaces children in a new set ofrelations that is no longerthe academic field of music. Why is the alchemy important? First, the alchemy ofschool subjects is a particular system of reason that fabricates the kinds of people administered in schooling. Second, the alchemy reconfigures the sensitivities and awarenesses of the field of music to make the child's "soul" the site of administration. That soul in music and other school subjects is talked about today as personaldevelopment, self-reflection,personality, and character. Third, school subjects are sites in which the relations between the state, society, community, and individuality are worked and reworked to produce the borders ofinclusion and exclusion. The first section of this paper considers school subjects as a practice of governing that administersprinciples (orstandards ifwecanplay with that word) about who we are and should be. The second section considers psychology as the translation device that transports academic disciplines into school subjects. It may seem odd at firstglancebutthesamepsychologicaltransportation systems exist across school subjects. The historical intervention of the transportation system, we argue in the third section, has little to do with understanding music or science, but with governing the soul. In that section we examine the different cultural practices that overlap to©Philosophy ofMusic Education Review 10, no. 2 (Fall, 2002): 80-91. Thomas S. Popkewitz/Ruth Gustafson 81 generate principles that orderthe nature ofmusic, the child/childhood, teaching, and reflection and subjectivity in music education. The discussion is not about the internal structure or the goodness ofmusic education but the particular frames of reference that form the evidence and possibilities of reform in school subjects. We take up the task ofinquiry into the alchemy of music as part of a broader project to show the contingency ofthe arrangement that we live by showing how thought has played a part in holding those arrangements together and to contestthe strategiesthatgovernthehumanpossibilities. The Art ofGoverning: Standards as Mapping Who We are/to Become Themodern state governs through developing a precise system of classifications and the correct sorting devices to chart a course ofaction that will change society for the better and which will prevent any futurejoining ofthe ranks ofthe poorly performing. To govern is to develop systems ofclassification that calculate and make legiblepeople fortheadministrationofthe society and the citizen. Mass schooling is a central institution in... (shrink)

WE AIM HERE to outline a theory of evidence for use. More specifically we lay foundations for a guide for the use of evidence in predicting policy effectiveness in situ, a more comprehensive guide than current standard offerings, such as the Maryland rules in criminology, the weight of evidence scheme of the International Agency for Research on Cancer (IARC), or the US ‘What Works Clearinghouse’. The guide itself is meant to be well-grounded but at the same time (...) to give practicable advice, that is, advice that can be used by policy-makers not expert in the natural and social sciences, assuming they are well-intentioned and have a reasonable but limited amount of time and resources available for searching out evidence and deliberating. (shrink)

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always (...) relevant to primary care and that undue emphasis placed on it can lead to conflict with a clinician’s duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care. (shrink)

This study contrasts the evidence exclusion principles within the adversarial legal system of the United States, particularly the “fruit of the poisonous tree” doctrine, with the inquisitorial system of Vietnam. The U.S. model, emphasizing the exclusion of unlawfully obtained evidence to protect the presumption of innocence and ensure fair trials, relies on the Fourth Amendment to prevent police misconduct. Conversely, Vietnam, with its focus on uncovering the truth, has started to adopt adversarial elements, including evidence exclusion, to (...) align with international standards and enhance human rights protections within its criminal justice system. The research examines the application of the “fruit of the poisonous tree” doctrine in the U.S. and its implications for Vietnamese legal reforms, especially the proposed amendments to Article 87 of Vietnam's Criminal Procedure Code. These reforms aim to exclude unlawfully obtained evidence while allowing for the use of evidence collected independently from illegal actions. Highlighting the need for a balanced approach that respects procedural rights and promotes justice, the study advocates for comprehensive legal reforms in Vietnam. It suggests amendments to refine evidence exclusion principles, ensuring they reflect both the Vietnamese context and the progressive features of U.S. criminal justice practices, thereby enhancing the fairness and integrity of criminal proceedings. (shrink)

The identification of a reference standard is a major problem in diagnostic imaging. This comment invites reflection on the notion by illustrating three philosophical approaches to truth and evidence.

This paper adds evidence structure to standard models of belief, in the form of families of sets of worlds. We show how these more fine-grained models support natural actions of “evidence management”, ranging from update with external new information to internal rearrangement. We show how this perspective leads to new richer languages for existing neighborhood semantics for modal logic. Our main results are relative completeness theorems for the resulting dynamic logic of evidence.

The recent Science Wars have brought into sharp focus, in a public forum, contentious questions about the authority of science and what counts as properly scientific practice that have long structured archaeological debate. As in the larger debate, localized disputes in archaeology often presuppose a conception of science as a unified enterprise defined by common goals, standards, and research programs; specific forms of inquiry are advocated (or condemned) by claiming afiliation with sciences so conceived. This pattern of argument obscures (...) much that is most creative in archaeological practice. Archaeologists routinely exploit both integrating and fragmenting relations among the sciences, especially in establishing evidential claim. I will argue that the credibility of these claims is a function, not of scientific status acquired by corporate affiliation, but of the substantive trade in tools and techniques, empirical insights, models, and theories that is made possible by local interactions between archaeology and a wide range of other disciplines. There is much more to be gained by developing a rich critical understanding of the interfield relations that make this trade possible than by appealing to generic ideals of science. (shrink)

BackgroundThe prevention of HIV remains an ongoing global concern. The safety and welfare of participants in these trials are imperative. Research Ethics Committees (RECs) review all reports of serious adverse events, adverse events and social harms arising in the course of such trials. There is little guidance for RECs on how to respond appropriately to social harm reports.MethodologyThis paper reviews the literature on social harms in HIV prevention trials and offers suggestions for RECs on how to respond appropriately to such (...) reports.ResultsThis review confirms that social harms are reported in clinical trials in South Africa and that specific guidance on managing these is minimal.ConclusionSocial harms in South African HIV prevention trials need to be more systematically researched so that ethical evidence‐based prevention, care and treatment strategies can be developed. This review makes specific suggestions for further research on social harms that can inform further consultations to develop more specific guidance for stakeholders on appropriate responses to such social harms. Such future work may also inform future versions of relevant local and international ethics guidance on HIV prevention trials. (shrink)

There are two reasons, I claim, scientists do and should ignore standard philosophical theories of objective evidence: (1) Such theories propose concepts that are far too weak to give scientists what they want from evidence, viz., a good reason to believe a hypothesis; and (2) They provide concepts that make the evidential relationship a priori, whereas typically establishing an evidential claim requires empirical investigation.

Extrapolation of causal claims from study populations to other populations of interest is a problematic issue. The standard approach in experimental research, which prioritises randomized controlled trials and statistical evidence, is not devoid of difficulties. Granted that, it has been defended that evidence of mechanisms is indispensable for causal extrapolation. We argue, contrarily, that this sort of evidence is not indispensable. Nonetheless, we also think that occasionally it may be helpful. In order to clarify its relevance, we (...) introduce a distinction between a positive and a negative role of evidence of mechanisms. Our conclusion is that the former is highly questionable, but the latter may be a trustworthy resource for causal extrapolation. (shrink)

As a way to make medical decisions, Evidence-Based Medicine (EBM) has failed. EBM's failure arises from not being founded on real-world decision-making. EBM aspires to a scientific standard for the best way to treat a disease and determine its cause, but it fails to recognise that the scientific method is inapplicable to medical and other real-world decision-making. EBM also wrongly assumes that evidence can be marshaled and applied according to an hierarchy that is determined in an argument by (...) authority to the method by which it has been obtained. If EBM had valid theoretical, practical or empirical foundations, there would be no hierarchy of evidence. In all real-world decision-making, evidence stands or falls on its inherent reliability. This has to be and can only be assessed on a case-by-case basis applying understanding and wisdom against the background of all available facts—the "factual matrix." EBM's failure is structural and was inevitable from its inception. EBM confuses the inherent reliability and probative value of evidence with the means by which it is obtained. -/- EBM is therefore an ad hoc construct and is not a valid basis for medical decision-making. This is further demonstrated by its exclusion of relevant scientific and probative real-world decision-making evidence and processes. It draws upon a narrow evidence base that is itself inherently unreliable. It fails to take adequate account of the nature of causation, the full range of evidence relevant to its determination, and differing approaches to determining cause and effect in real-world decision-making. EBM also makes a muddled attempt to emulate the scientific method and it does not acknowledge the role of experience, understanding and wisdom in making medical decisions. (shrink)