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)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of uncertainty." (...) One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)

ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. These populations (...) cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

Purpose This short viewpoint is a response to a lead paper on professional ethics in the information age. This paper aims to draw upon the authors’ experience of professional bodies such as the ACM over many years. Points of agreement and disagreement are highlighted with the aim of promoting wider debate. Design/methodology/approach An analysis of the lead paper is undertaken using a binary agree/disagree approach. This highlights the conflicting views which can then be considered in more detail. Findings Four major (...) agreements and four major disagreements are identified. There is an emphasis on “acultural” professionalism to promote moral behavior rather than amoral behavior. Originality/value This is an original viewpoint which draws from the authors’ practical experience and expertise. (shrink)

We say that $\mathcal {I}$ is an ideal independent family if no element of ${\mathcal {I}}$ is a subset mod finite of a union of finitely many other elements of ${\mathcal {I}}.$ We will show that the minimum size of a maximal ideal independent family is consistently bigger than both $\mathfrak {d}$ and $\mathfrak {u},$ this answers a question of Donald Monk.

Stewart's purpose is to show that Hume is not a political conservative, but is better understood as a liberal. The author is reacting against several recent works on Hume: David Miller's Philosophy and Ideology in Hume's Political Thought, Donald W. Livingston's Hume's Philosophy of Common Life, and Frederick G. Whelan's Order and Artifice in Hume's Political Philosophy. These "all share, with variations, the nineteenth-century view that Hume's epistemology led him to conservatism". Stewart acknowledges that the term "conservative" is (...) used in different ways by these authors, but not so differently that they cannot be collectively refuted by showing Hume to be a liberal, that is, one "who thought that major reforms were highly desirable in the United Kingdom in the late-eighteenth and early-nineteenth centuries". Stewart is referring here to substantial "economic and political reforms," but not to "socialist, Marxist, or neoliberal reforms.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.1 (2000) 153-156 [Access article in PDF] JHI 2000 Donald R. Kelley It was just sixty years ago that this Journal first made its appearance. Two hundred thirty-nine issues later it continues in a world transformed by war, overpopulation, cultural shocks, scientific and technological transformations, globalization, the avalanche of information produced by electronic exchange, and "the acceleration of just about everything." Yet (...) despite these factors and the strains of postmodernism and cultural alterity, 1 it has not entirely lost touch with its intellectual innocence, faith in humanistic learning, and reliance on enlightened reason. This continuity itself may seem something of a novelty in an age of distrust of history and "rage against reason," but for some of us it reflects the critical spirit and intellectual context out of which such ostensibly subversive attitudes emerge, and reemerge. To some extent, moreover, the diversity of opinions about intellectual traditions is the result of specializations, and special interests, which have changed the climate of opinion since the time of Arthur O. Lovejoy, principal founder of the JHI. Lovejoy's vision was super- as well as inter-disciplinary; that is, he intended to include in the agenda of "history of ideas" particular areas of history of philosophy, literature, art, science, social science, etc., as well as the larger intellectual and cultural areas into which these disciplinary histories extend. 2 These days, however, all these disciplinary traditions have their own more specialized journals and do not need to seek a vehicle in publications of more general interest. What remains then, for the most part, is the interdisciplinary arena in which larger questions of human experience should be posed--and for Lovejoy, as for so many epigones and critics, the main "larger question" is not only one of value but also of specifically historical inquiry. 3 [End Page 153]The first issue of the JHI appeared under the editorship of Lovejoy (with Philip Wiener, who did most of the editorial work, as "managing editor"), assisted by a committee that included two historians, three philosophers, four literary scholars, and one political theorist; namely, Crane Brinton, Gilbert Chinard, Morris Cohen, Francis Coker, Richard McKeon, Perry Miller, Marjory Nicolson, J. H. Randall, J. Salwyn Schapiro, and Louis Wright. The first volume featured contributions from each of these, including Wiener, except for Miller (vol. 2), Shapiro (vol. 3), McKeon (vol. 8), and Coker. 4 During the first five years there were also reviews of books by Dilthey (by Horace L. Friess), Croce (Schapiro), Mannheim (Randall), Perry Miller (Herbert W. Schneider), Van Wyck Brooks (Miller) and Alfred Kazin (F. O. Matthiessen). In this period the disciplinary distribution of articles was not markedly different from that of the past five years, nor was the ranking of fields by number of submissions. 5 Most important, the original interdisciplinary thrust of Lovejoy's agenda, if not his attachment to the spiritualist currency of "unit-ideas," has survived growing specialization.At first the history of ideas was pursued largely in the shadow of the history of philosophy; for in this field, according to Lovejoy, "is to be found the common seed-plot, the locus of initial manifestation in writing, of the greater number of the more fundamental and pervasive ideas, and especially of the ruling preconceptions, which manifest themselves in other regions of intellectual history." 6 Lovejoy's concern was always with concepts, especially "-isms," and yet in some ways he anticipated the "linguistic turn" of the later years of this century, pointing out in particular "the role of semantic shifts, ambiguities, and confusions, in the history of thought and taste," for "nearly all of the great catchwords have been equivocal--or rather, multivocal." 7 If ideas could be given stable definitions, they were nonetheless often, in the context of language, in conflict, even in the mind of a single thinker; for such was the "anomaly of knowledge." 8 So Lovejoy was at pains to distinguish the various meanings of [End Page 154] catch-words like "nature," "perfectibility," "romanticism," "progress," and "pragmatism," not to mention more inflammatory terms of wartime ideological debate.But... (shrink)

The most popular and convincing arguments for the claim that vegetarianism is morally obligatory focus on the extensive, unnecessary harm done to animals and to the environment by raising animals industrially in confinement conditions (factory farming). I outline the strongest versions of these arguments. I grant that it follows from their central premises that purchasing and consuming factoryfarmed meat is immoral. The arguments fail, however, to establish that strict vegetarianism is obligatory because they falsely assume that eating vegetables is the (...) only alternative to eating factory-farmed meat that avoids the harms of factory farming. I show that these arguments not only fail to establish that strict vegetarianism is morally obligatory, but that the very premises of the arguments imply that eating some (non-factory-farmed) meat rather than only vegetables is morally obligatory. Therefore, if the central premises of these usual arguments are true, then strict vegetarianism is immoral. (shrink)

Starting with Gottlob Frege's foundational theories of sense and reference, Miller provides a useful introduction to the formal logic used in all subsequent philosophy of language. He communicates a sense of active philosophical debate by confronting the views of the early theorists concerned with building systematic theories - such as Frege, Bertrand Russell, and the logical positivists - with the attacks mounted by sceptics - such as W.O. Quine, Saul Kripke, and Ludwig Wittgenstein. This leads to important excursions into (...) related areas of metaphysics, philosophy of mind, and cognitive science that present the more recent attempts to save the notions of sense and meaning by philosophers such as Paul Grice, John Searle, Jerry Fodor, Colin McGinn, and Crispin Wright. Miller then returns to the systematic program by examining the formal theories of Donald Davidson, concluding with a chapter surveying the relevance of philosophy of language to the broader metaphysical debates between realists and anti-realists. Miller's clear, engaged, and coherently structured approach makes Philosophy of Language an ideal text for undergraduate courses. The guides to further reading provided in each chapter help the reader pursue interesting topics further and facilitate using the book in conjunction with primary sources. (shrink)

Hegel is an immensely important yet difficult philosopher. His Philosophy of Mind is one of the main pillars of his thought. Michael Inwood, highly respected for his previous work on Hegel, presents this central work to the modern reader in an accurate new translation supported by a philosophically sophisticated editorial introduction and elucidating scholarly commentary.

This essay examines several recent philosophical attempts to define ‘disease’. Two prominent ones are considered in detail, an objective approach by Christopher Boorse and a normative approach by Caroline Whitbeck. Both are found to be inadequate for a variety of reasons, though Whitbeck's is superior because of her careful preliminary distinctions and because of its normative approach which is more nearly in accord with medical and lay usage. The paper concludes with a discussion of the nature of such efforts at (...) definition and suggests that their limitations are due both to the nature of our language and concepts in general, and to the nature of medicine in particular. It is the practical and changing character of medicine and its language that frustrates the efforts of philosophers to formulate such definitions. Keywords: disease, definition CiteULike Connotea Del.icio.us What's this? (shrink)

Our century has witnessed violence on an unprecedented scale, in wars that have torn deep into the fabric of national and international life. And as we can see in the recent strife in Bosnia, genocide in Rwanda, and the ongoing struggle to control nuclear weaponry, ancient enmities continue to threaten the lives of masses of human beings. As never before, the question is urgent and practical: How can nations--or ethnic groups, or races--after long, bitter struggles, learn to live side by (...) side in peace? In An Ethic for Enemies, Donald W. Shriver, Jr., President Emeritus of Union Theological Seminary, argues that the solution lies in our capacity to forgive. Taking forgiveness out of its traditional exclusive association with personal religion and morality, Shriver urges us to recognize its importance in the secular political arena. The heart of the book examines three powerful and moving cases from recent American history--our postwar dealings with Germany, with Japan, and our continuing domestic problem with race relations--cases in which acts of forgiveness have had important political consequences. Shriver traces how postwar Germany, in its struggle to break with its political past, progressed from denial of a Nazi past, to a formal acknowledgement of the crimes of Nazi Germany, to providing material compensation for survivors of the Holocaust. He also examines the efforts of Japan and the United States, over time and across boundaries of race and culture, to forgive the wrongs committed by both peoples during the Pacific War. And finally he offers a fascinating discussion of the role of forgiveness in the American civil rights movement. He shows, for instance, that even Malcolm X recognized the need to move from contempt for the integrationist ideal to a more conciliatory, repentant stance toward Civil Rights leaders. Malcolm came to see that only through forgiveness could the separate voices of the African-American movement work together to achieve their goals. If mutual forgiveness was a radical thought in 1964, Shriver reminds us that it has yet to be realized in 1994. "We are a long way from ceasing to hold the sins of the ancestors against their living children," he writes. Yet in this poignant volume, we discover how, by forgiving, enemies can progress and have progressed toward peace. A timely antidote to today's political conflicts, An Ethic for Enemies challenges to us to confront the hatreds that cripple society and threaten to destroy the global village. (shrink)

Richard Miller presents a bold new program for international justice. He argues for new standards of responsible conduct by governments, firms, and individuals in developed countries, to govern trade, investment, environmental policy, and the use of force. He offers an urgently needed strategy for moving humanity toward genuine global co-operation.

An adaptive preference is a preference that is regimented in response to an agent’s set of feasible options. The fabled fox in the sour grapes story undergoes an adaptive preference change. I consider adaptive preferences more broadly, to include adaptive preference formation as well. I argue that many adaptive preferences that other philosophers have cast out as irrational sour-grapes-like preferences are actually fully rational preferences worthy of pursuit. I offer a means of distinguishing rational and worthy adaptive preferences from irrational (...) and unworthy ones. The distinction is based on the agent’s own appraisal of the adaptive preference. (shrink)

Immanuel Kant was a German philosopher. He is a central figure of modern philosophy, and set the terms by which all subsequent thinkers have had to grapple. He argued that human perception structures natural laws, and that reason is the source of morality. His thought continues to hold a major influence in contemporary thought, especially in fields such as metaphysics, epistemology, ethics, political philosophy, and aesthetics.

Applying the rules and systems of mathematics and logic to instance ontology, this work argues for the validity and problem-solving capacities of instance ontology, and associates it with a version of the realist position which is named by the author as moderate realism.

There is almost no theoretical discussion of non‐human animal well‐being in the philosophical literature on well‐being. To begin to rectify this, I develop a desire satisfaction theory of well‐being for animals. I contrast this theory with my desire theory of well‐being for humans, according to which a human benefits from satisfying desires for which she can offer reasons. I consider objections. The most important are (1) Eden Lin's claim that the correct theory of well‐being cannot vary across different welfare subjects (...) and (2) his objection against theories of human well‐being that require exercising a sophisticated capacity such as reason giving. (shrink)

Institutional corruption is a normative concept of growing importance that embodies the systemic dependencies and informal practices that distort an institution’s societal mission. An extensive range of studies and lawsuits already documents strategies by which pharmaceutical companies hide, ignore, or misrepresent evidence about new drugs; distort the medical literature; and misrepresent products to prescribing physicians. We focus on the consequences for patients: millions of adverse reactions. After defining institutional corruption, we focus on evidence that it lies behind the epidemic of (...) harms and the paucity of benefits. (shrink)

Whitehead's magnum opus is as important as it is difficult. It is the only work in which his metaphysical ideas are stated systematically and completely, and his metaphysics are the heart of his philosophical system as a whole.

Over the past 35 years, patients have suffered from a largely hidden epidemic of side effects from drugs that usually have few offsetting benefits. The pharmaceutical industry has corrupted the practice of medicine through its influence over what drugs are developed, how they are tested, and how medical knowledge is created. Since 1906, heavy commercial influence has compromised congressional legislation to protect the public from unsafe drugs. The authorization of user fees in 1992 has turned drug companies into the FDA's (...) prime clients, deepening the regulatory and cultural capture of the agency. Industry has demanded shorter average review times and, with less time to thoroughly review evidence, increased hospitalizations and deaths have resulted. Meeting the needs of the drug companies has taken priority over meeting the needs of patients. Unless this corruption of regulatory intent is reversed, the situation will continue to deteriorate. We offer practical suggestions including: separating the funding of clinical trials from their conduct, analysis, and publication; independent FDA leadership; full public funding for all FDA activities; measures to discourage R&D on drugs with few, if any, new clinical benefits; and the creation of a National Drug Safety Board. (shrink)

Here Donald Livingston traces this distinction through all of Hume's writings and reveals its relevance for contemporary discussion.

One version of the desire satisfaction theory of well-being (i.e., welfare, or what is good for one) holds that only the satisfaction of one's present desires for present states of affairs can affect one's well-being. So if I desire fame today and become famous tomorrow, my well-being is positively affected onlyif tomorrow, when I am famous, I still desire to be famous. Call this the present desire satisfaction theory of well-being. I argue, contrary to this theory, that the satisfaction of (...) past desires that are no longer held does indeed affect one's well-being. The satisfaction of past desires is good for one in that the present satisfaction of past desires positively affects one's past well-being. I argue for this view in stages, starting with the recognition that many of our desires are satisfied not at an instant but over an interval of time, and that it is during this interval of time that our well-being is positively affected. Once we get our foot in the door with some temporal thickness to desire satisfaction and the associated well-being, I argue, the door must open more widely to allow for greater temporal distance between present desire satisfaction and past well-being. I defend my thesis that present satisfaction of past desires increases one's past welfare against objections, including the claim that it involves backward causation and Velleman's claim that the view is highly counterintuitive whether or not it involves backward causation. I argue that some of the objections rely on hedonistic intuitions, intuitions that most desire satisfaction theories of welfare aim to correct. Once properly understood and applied, my counterintuitive and controversial thesis is really quite innocuous. (shrink)

Hugh LaFollette, Jeff McMahan, and David DeGrazia endorse the most popular and convincing argument for the strict regulation of firearms in the U.S. The argument is based on the extensive, preventable harm caused by firearms. DeGrazia offers another compelling argument based on the rights of those threatened by firearms. My thesis is a conditional: if these usual arguments for gun control succeed, then alcoholic beverages should be controlled much more strictly than they are, possibly to the point of prohibition. The (...) argument for this thesis involves developing a careful analogy between firearms and alcohol and defending the analogy against objections. (shrink)

Hugh LaFollette, Jeff McMahan, and David DeGrazia endorse the most popular and convincing argument for the strict regulation of firearms in the U.S. The argument is based on the extensive, preventable harm caused by firearms. DeGrazia offers another compelling argument based on the rights of those threatened by firearms. My thesis is a conditional: if these usual arguments for gun control succeed, then alcoholic beverages should be controlled much more strictly than they are, possibly to the point of prohibition. The (...) argument for this thesis involves developing a careful analogy between firearms and alcohol and defending the analogy against objections. (shrink)

In the continuing discussion and debate over the development of letter-forms in fifth-century Athens, the official casualty lists from the public cemetery have played little part. One of them, however, the so-called ‘Koroneia’ epigram and related fragments , has been used in the argument by H. B. Mattingly, who has assigned it to Delion and claims its tailed rho for the 420s. But, the epigraphical argument aside, it seems to me that in so doing he has ignored two important characteristics (...) of the lists—characteristics that are not apparent from these fragments by themselves but that can be seen from all the inscriptions of this class taken as a group. No summary of our knowledge of these lists has been written for almost 50 years, during which time the number known has almost doubled. In this paper I should like to outline the present state of our knowledge and to give some impressions of them gained from examining all known fragments and preparing them for publication. I wish to stress that these impressions were formed slowly, with no parti pris, no idea of their being used in any debate over letter-forms, but merely with the purpose of understanding as much as possible about the lists as a group. (shrink)

Donald Shriver argues that recognition of morally negative events in American history is essential to the health of our society. The failure to acknowledge and repent of these events skews the relations of many Americans to one another and breeds ongoing hostility. Focusing on the wrongs suffered by African Americans and Native Americans, Shriver examines the challenges associated with the call for collective repentance: What can it mean to morally master a past whose victims are dead and whose sufferings (...) cannot be alleviated? What are the measures that lend substance to language and action expressing repentance? In answering these questions Shriver creates a compelling vision of the collective repentance and apology that must precede real progress in relations between the races in this country. (shrink)

A theory of rationality evaluates actions and actors as rational or irrational. Assessing preferences themselves as rational or irrational is contrary to the orthodox view of rational choice. The orthodox view takes preferences as given, holding them beyond reproach, and assesses actions as rational or irrational depending on whether the actions tend to serve as effective means to the satisfaction of the given preferences. Against this view, this paper argues that preferences themselvesare indeed proper objects of rational evaluation. This evaluation (...) of preferences is driven by whether holding and acting on them conduces to, or interferes with the satisfaction of other, more important preferences. Taking the lead from methods in moral theory of holding individuals responsible for their moral or immoral character traits, this paper goes on to sketch parallel ways of determining an agent’s rational responsibility for her rational or irrational preferences. (shrink)

In a well-known paper, Bernard Williams argues that an immortal life would not be worth living, for it would necessarily become boring. I examine the implications for the boredom thesis of three human traits that have received insufficient attention in the literature on Williams’ paper. First, human memory decays, so humans would be entertained and driven by things that they experienced long before but had forgotten. Second, even if memory does not decay to the extent necessary to ward off boredom, (...) once-satisfied desires often return after a sufficient period of time. Eternity would always contain sufficient time for our desires to rejuvenate. Third, even if too many of our desires were satisfied but not yet rejuvenated, we can expect that human ingenuity would continue to invent new pursuits, pastimes, careers, and ways of life that would prevent us from becoming bored as we moved from one to another. Finally, I consider and respond to several objections, including the claims that as much variety as I propose to be put into an eternal life is inconsistent with having one character throughout one’s life and that the sort of character change and memory decay I postulate is inconsistent with personal identity. (shrink)

Cognitive neuroscientists have anticipated the union of neural and behavioral science with ethics (Gazzaniga 2005). The identification of an ethical rule—the dictum that we should treat others in the manner in which we would like to be treated—apparently widespread among human societies suggests a dependence on fundamental human brain mechanisms. Now, studies of neural and molecular mechanisms that underlie the feeling of fear suggest how this form of ethical behavior is produced. Counterintuitively, a new theory presented here states that it (...) is actually a loss of social information that leads to sharing others' fears with our own, thus allowing us to treat others as we would like to be treated. Adding to that hypothetical mechanism is the well-studied predilection toward affiliative behaviors. Thus, even as Chomsky hypothesizes that humans are predisposed to utter grammatical sentences, we propose that humans are 'wired for reciprocity'. However, these two neural forces supporting ethical behavior do not explain individual or collective violence. At any given moment, the ability to produce behavior that obeys this ethical rule is proposed to depend on a balance between mechanisms for prosocial and antisocial behaviors. That balance results not only from genetic influences on temperament but also from environmental effects particularly during critical neonatal and pubertal periods. (shrink)

Although human well-being is a topic of much contemporary philosophical discussion, there has been comparatively little theoretical discussion in philosophy of (nonhuman) animal well-being. Animal welfare science is a well-established scientific discipline that studies animal well-being from an empirical standpoint. This article examines parts of this literature that may be relevant to philosophical treatments of animal well-being and to other philosophical issues. First, I explain the dominant conceptions of well-being in animal welfare science and survey some debates in that literature (...) surrounding these competing conceptions. Second, I explain the empirical methods used to measure animal well-being. Third, I argue for the philosophical relevance of the research in animal welfare science and outline some philosophical issues concerning animal welfare and its science that I claim are worthy of attention by philosophers. (shrink)