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  1. Believing in Black Boxes: Must Machine Learning in Healthcare be Explainable to be Evidence-Based?Liam McCoy, Connor Brenna, Stacy Chen, Karina Vold & Sunit Das - forthcoming - Journal of Clinical Epidemiology.
    Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...)
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  2. Reviewing the Reproduction Number R in Covid-19 Models.Maria Cristina Amoretti & Elisabetta Lalumera - 2022 - Philosophy of Medicine 3 (1).
    Most of the epidemiological models of the Covid-19 pandemic contain the reproduction number as a parameter. In this article we focus on some shortcomings regarding its role in driving health policies and political decisions. First, we summarize what R is and what it is used for. Second, we introduce a three-question matrix for the evaluation of any construct or parameter within a model. We then review the main literature about R to highlight some of its shortcomings and apply to them (...)
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  3. Holism and Reductionism in the Illness/Disease Debate.Marco Buzzoni, Luigi Tesio & Michael T. Stuart - 2022 - In Shyam Wuppuluri & Ian Stewart (eds.), From Electrons to Elephants and Elections. Springer. pp. 743-778.
    In the last decades it has become clear that medicine must find some way to combine its scientific and humanistic sides. In other words, an adequate notion of medicine requires an integrative position that mediates between the analytic-reductionist and the normative-holistic tendencies we find therein. This is especially important as these different styles of reasoning separate “illness” (something perceived and managed by the whole individual in concert with their environment) and “disease” (a “mechanical failure” of a biological element within the (...)
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  4. Inconvenient Truth and Inductive Risk in Covid-19 Science.Eli I. Lichtenstein - 2022 - Philosophy of Medicine 3 (1):1-25.
    To clarify the proper role of values in science, focusing on controversial expert responses to Covid-19, this article examines the status of (in)convenient hypotheses. Polarizing cases like health experts downplaying mask efficacy to save resources for healthcare workers, or scientists dismissing “accidental lab leak” hypotheses in view of potential xenophobia, plausibly involve modifying evidential standards for (in)convenient claims. Societies could accept that scientists handle (in)convenient claims just like nonscientists, and give experts less political power. Or societies could hold scientists to (...)
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  5. Why homoeopathy is pseudoscience.Nikil Mukerji & Edzard Ernst - 2022 - Synthese 200 (5):1-29.
    Homoeopathy is commonly recognised as pseudoscience. However, there is, to date, no systematic discussion that seeks to establish this view. In this paper, we try to fill this gap. We explain the nature of homoeopathy, discuss the notion of pseudoscience, and provide illustrative examples from the literature indicating why homoeopathy fits the bill. Our argument contains a conceptual and an empirical part. In the conceptual part, we introduce the premise that a doctrine qualifies as a pseudoscience if, firstly, its proponents (...)
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  6. 143 An ethical analysis of evidence-based medicine.Wesley J. Park - 2022 - BMJ Evidence-Based Medicine 27 (Suppl 2):A12.
    Evidence-based medicine is a clinical decision making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science evidence-based medicine is a value laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based medicine endorses (...)
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  7. Relaxing Mask Mandates in New Jersey: A Tale of Two Universities.Wesley J. Park - 2022 - Voices in Bioethics 8.
    The ethical question is whether university mask mandates should be relaxed. I argue that the use of face masks by healthy individuals has uncertain benefits, which potential harms may outweigh, and should therefore be voluntary. Systematic reviews by the World Health Organization (WHO) and Cochrane Acute Respiratory Infections concluded that the use of face masks by healthy individuals in the community lacks effectiveness in reducing viral transmission based on moderate-quality evidence. The only two randomized controlled trials of face masks published (...)
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  8. 16 The logic of lockdowns: a game of modeling and evidence.Wesley J. Park - 2022 - BMJ Evidence-Based Medicine 27 (Suppl 1):A59.
    Lockdowns, or modern quarantines, involve the use of novel restrictive non-pharmaceutical interventions (NPIs) to suppress the transmission of COVID-19. In this paper, I aim to critically analyze the emerging history and philosophy of lockdowns, with an emphasis on the communication of health evidence and risk for informing policy decisions. I draw a distinction between evidence-based and modeling-based decision-making. I argue that using the normative framework of evidence-based medicine would have recommended against the use of lockdowns. I first review the World (...)
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  9. 175 An ethical analysis of evidence-based medicine.Wesley J. Park - 2022 - BMJ Evidence-Based Medicine 27 (Suppl 1):A48.
    Evidence-based medicine is a clinical decision-making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science, evidence-based medicine is a value-laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based medicine endorses expected utility (...)
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  10. COVID-19 and the unseen pandemic of child abuse.Wesley J. Park & Kristen A. Walsh - 2022 - BMJ Paediatrics Open 6 (1).
    For children, the collateral damage of the COVID-19 pandemic response has been considerable. In this paper, we use the framework of evidence-based medicine to argue that child abuse is another negative side effect of COVID-19 lockdowns. While it was certain that school closures would have profound social and economic costs, it remains uncertain whether they have any effect on COVID-19 transmission. There is emerging evidence that lockdowns significantly worsened child abuse on a global scale. Low-income and middle-income countries are particularly (...)
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  11. Evidence of Biological Mechanisms and Health Predictions: An Insight into Clinical Reasoning.Saúl Pérez-González & Elena Rocca - 2022 - Perspectives in Biology and Medicine 65 (1):89-105.
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  12. Cognitive biases and the predictable perils of the patient‐centric free‐market model of medicine.Michael J. Shaffer - 2022 - Metaphilosophy 53 (4):446-456.
    This paper addresses the recent rise of the use of alternative medicine in Western countries. It offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical modalities. The explanatory theory defended (...)
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  13. Wishful Intelligibility, Black Boxes, and Epidemiological Explanation.Marina DiMarco - 2021 - Philosophy of Science 88 (5):824-834.
    Epidemiological explanation often has a “black box” character, meaning the intermediate steps between cause and effect are unknown. Filling in black boxes is thought to improve causal inferences by making them intelligible. I argue that adding information about intermediate causes to a black box explanation is an unreliable guide to pragmatic intelligibility because it may mislead us about the stability of a cause. I diagnose a problem that I call wishful intelligibility, which occurs when scientists misjudge the limitations of certain (...)
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  14. Follow *the* science? On the marginal role of the social sciences in the COVID-19 pandemic.Simon Lohse & Stefano Canali - 2021 - European Journal for Philosophy of Science 11 (4):1-28.
    In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for (...)
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  15. Assessing the role of evidence of mechanisms in causal extrapolation.Saúl Pérez-González & Valeriano Iranzo - 2021 - Theoria: Revista de Teoría, Historia y Fundamentos de la Ciencia 36 (2):211-228.
    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 (...)
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  16. Evidence, Defeasibility, and Metaphors in Diagnosis and Diagnosis Communication.Pietro Salis & Francesca Ervas - 2021 - Topoi 40 (2):327–341.
    The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic evidence as defeasible as well. (...)
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  17. Applying Evidential Pluralism to the Social Sciences.Yafeng Shan & Jon Williamson - 2021 - European Journal for Philosophy of Science 11 (4):1-27.
    Evidential Pluralism maintains that in order to establish a causal claim one normally needs to establish the existence of an appropriate conditional correlation and the existence of an appropriate mechanism complex, so when assessing a causal claim one ought to consider both association studies and mechanistic studies. Hitherto, Evidential Pluralism has been applied to medicine, leading to the EBM+ programme, which recommends that evidence-based medicine should systematically evaluate mechanistic studies alongside clinical studies. This paper argues that Evidential Pluralism can also (...)
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  18. The road from evidence to policies and the erosion of the standards of democratic scrutiny in the COVID-19 pandemic.Davide Vecchi & Giorgio Airoldi - 2021 - History and Philosophy of the Life Sciences 43 (2):1-5.
    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 (...)
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  19. Medical Nihilism by Jacob Stegenga: What is the right dose? [REVIEW]Jonathan Fuller - 2020 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 81.
  20. The Illusion of Evidence-Based Medicine: Exposing the Crisis of Credibility in Clinical Research.Leemon McHenry & Jon Jureidini - 2020 - Adelaide SA, Australia: Wakefield Press.
    We live in an age alleged devoted to evidence-based medicine. Evidence-based medicine, however, depends on reliable data and if the data are largely, if not completely, manipulated by the manufacturer of pharmaceuticals, then the data are not reliable. Evidence-based medicine is an illusion. This book raises and attempts to answer the following questions: What are the ways in which the profit motive of industry undermines the integrity of science? How is science protected from corporate malfeasance in a capitalist economy? Our (...)
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  21. Experiential knowledge in clinical medicine: use and justification.Mark R. Tonelli & Devora Shapiro - 2020 - Theoretical Medicine and Bioethics 41 (2):67-82.
    Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...)
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  22. Randomized Controlled Trials for Diagnostic Imaging: Conceptual and Pratical Problems.Elisabetta Lalumera & Stefano Fanti - 2019 - Topoi 38 (2):395-400.
    We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this (...)
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  23. Warranted Diagnosis.David Limbaugh, David Kasmier, Werner Ceusters & Barry Smith - 2019 - In Proceedings of the International Conference on Biomedical Ontology (ICBO), Buffalo, NY. Buffalo: pp. 1-10.
    A diagnostic process is an investigative process that takes a clinical picture as input and outputs a diagnosis. We propose a method for distinguishing diagnoses that are warranted from those that are not, based on the cognitive processes of which they are the outputs. Processes designed and vetted to reliably produce correct diagnoses will output what we shall call ‘warranted diagnoses’. The latter are diagnoses that should be trusted even if they later turn out to have been wrong. Our work (...)
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  24. Rules versus Standards: What Are the Costs of Epistemic Norms in Drug Regulation?David Teira & Mattia Andreoletti - 2019 - Science, Technology, and Human Values 44 (6):1093-1115.
    Over the last decade, philosophers of science have extensively criticized the epistemic superiority of randomized controlled trials for testing safety and effectiveness of new drugs, defending instead various forms of evidential pluralism. We argue that scientific methods in regulatory decision-making cannot be assessed in epistemic terms only: there are costs involved. Drawing on the legal distinction between rules and standards, we show that drug regulation based on evidential pluralism has much higher costs than our current RCT-based system. We analyze these (...)
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  25. Evidence based or person centered? An ontological debate.Rani Lill Anjum - 2016 - European Journal for Person Centered Healthcare 4 (2):421-429.
    Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed (...)
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  26. Mechanistic Information as Evidence in Decision-Oriented Science.José Luis Luján, Oliver Todt & Juan Bautista Bengoetxea - 2016 - Journal for General Philosophy of Science / Zeitschrift für Allgemeine Wissenschaftstheorie 47 (2):293-306.
    Mechanistic information is used in the field of risk assessment in order to clarify two controversial methodological issues, the selection of inference guides and the definition of standards of evidence. In this paper we present an analysis of the concept of mechanistic information in risk assessment by recurring to previous philosophical analyses of mechanistic explanation. Our conclusion is that the conceptual analysis of mechanistic explanation facilitates a better characterization of the concept of mechanistic information. However, it also shows that the (...)
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  27. Epidemiological Explanations. [REVIEW]Olaf Dammann - 2015 - Philosophy of Science 82 (3):509-519.
  28. How norms make causes.Maria Kronfeldner - 2014 - International Journal of Epidemiology 43:1707–1713.
    This paper is on the problem of causal selection and comments on Collingwood's classic paper "The so-called idea of causation". It discusses the relevance of Collingwood’s control principle in contemporary life sciences and defends that it is not the ability to control, but the willingness to control that often biases us towards some rather than other causes of a phenomenon. Willingness to control is certainly only one principle that influences causal selection, but it is an important one. It shows how (...)
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  29. Book Review Jeremy Howick , The Philosophy of Evidence-Based Medicine . Chichester: Wiley-Blackwell (2011), 248 pp., $61.95 (paper). [REVIEW]Alex Broadbent - 2013 - Philosophy of Science 80 (1):165-168.
  30. Causal inference, mechanisms, and the Semmelweis case.Raphael Scholl - 2013 - Studies in History and Philosophy of Science Part A 44 (1):66-76.
    Semmelweis’s discovery of the cause of puerperal fever around the middle of the 19th century counts among the paradigm cases of scientific discovery. For several decades, philosophers of science have used the episode to illustrate, appraise and compare views of proper scientific methodology.Here I argue that the episode can be profitably reexamined in light of two cognate notions: causal reasoning and mechanisms. Semmelweis used several causal reasoning strategies both to support his own and to reject competing hypotheses. However, these strategies (...)
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  31. On the impartiality of early British clinical trials.David Teira - 2013 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 44 (3):412-418.
    Did the impartiality of clinical trials play any role in their acceptance as regulatory standards for the safety and efficacy of drugs? According to the standard account of early British trials in the 1930s and 1940s, their impartiality was just rhetorical: the public demanded fair tests and statistical devices such as randomization created an appearance of neutrality. In fact, the design of the experiment was difficult to understand and the British authorities took advantage of it to promote their own particular (...)
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  32. Possibilities and limits of medical science: Debates over double‐blind clinical trials of intercessory prayer.Wendy Cadge - 2012 - Zygon 47 (1):43-64.
    . This article traces the intellectual history of scientific studies of intercessory prayer published in English between 1965 and the present by focusing on the conflict and discussion they prompted in the medical literature. I analyze these debates with attention to how researchers articulate the possibilities and limits medical science has for studying intercessory prayer over time. I delineate three groups of researchers and commentators: those who think intercessory prayer can and should be studied scientifically, those who are more skeptical (...)
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  33. EnviroGenomarkers: The Interplay Between Mechanisms and Difference Making in Establishing Causal Claims.Federica Russo & Jon Williamson - 2012 - Medicine Studies 3 (4):249-262.
    According to Russo and Williamson (Int Stud Philos Sci 21(2):157–170, 2007, Hist Philos Life Sci 33:389–396, 2011a, Philos Sci 1(1):47–69, 2011b ), in order to establish a causal claim of the form, ‘_C_ is a cause of _E_’, one typically needs evidence that there is an underlying mechanism between _C_ and _E_ as well as evidence that _C_ makes a difference to _E_. This thesis has been used to argue that hierarchies of evidence, as championed by evidence-based movements, tend to (...)
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  34. Spin doctors.Michael Loughlin - 2010 - The Philosophers' Magazine 51 (51):68-73.
    Evidence Based Medicine is a thesis about reasoning: it champions a certain way of thinking about practice, one based not on the particular, not on thecontext-specific, but on broad statistical concerns. It emphasises “the increasing realisation of the power of probabilistic reasoning” to establish “a new epidemiologic standard”. So the claims of the “EBMers” imply a whole position in medical epistemology. But authors seem unwilling to give a detailed exposition, let alone defence of this position to critics. Hence the accusations (...)
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  35. Health Behavior Change and Treatment Adherence: Evidence-Based Guidelines for Improving Healthcare.Leslie Martin, Kelly Haskard-Zolnierek & M. Robin DiMatteo - 2010 - Oxford University Press USA.
    Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...)
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  36. Profitable failure: antidepressant drugs and the triumph of flawed experiments.Linsey McGoey - 2010 - History of the Human Sciences 23 (1):58-78.
    Drawing on an analysis of Irving Kirsch and colleagues’ controversial 2008 article in PLoS [Public Library of Science] Medicine on the efficacy of SSRI antidepressant drugs such as Prozac, I examine flaws within the methodologies of randomized controlled trials (RCTs) that have made it difficult for regulators, clinicians and patients to determine the therapeutic value of this class of drug. I then argue, drawing analogies to work by Pierre Bourdieu and Michael Power, that it is the very limitations of RCTs (...)
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  37. Randomized Controlled Trials and the Flow of Information: Comment on Cartwright.Sherrilyn Roush - 2009 - Philosophical Studies 143 (1):137-145.
    The transferability problem—whether the results of an experiment will transfer to a treatment population—affects not only Randomized Controlled Trials but any type of study. The problem for any given type of study can also, potentially, be addressed to some degree through many different types of study. The transferability problem for a given RCT can be investigated further through another RCT, but the variables to use in the further experiment must be discovered. This suggests we could do better on the epistemological (...)
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  38. Causal (mis)understanding and the search for scientific explanations: A case study from the history of medicine.Leen De Vreese - 2008 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 39 (1):14-24.
    In 1747, James Lind carried out an experiment which proved the usefulness of citrus fruit as a cure for scurvy. Nonetheless, he rejected the earlier hypothesis of Bachstrom that the absence of fresh fruit and vegetables was the only cause of the disease. I explain why it was rational for James Lind not to accept Bachstrom’s explanation. I argue that it was the urge for scientific understanding that guided Lind in his rejection and in the development of his alternative theory (...)
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  39. Interpreting causality in the health sciences.Federica Russo & Jon Williamson - 2007 - International Studies in the Philosophy of Science 21 (2):157 – 170.
    We argue that the health sciences make causal claims on the basis of evidence both of physical mechanisms, and of probabilistic dependencies. Consequently, an analysis of causality solely in terms of physical mechanisms or solely in terms of probabilistic relationships, does not do justice to the causal claims of these sciences. Yet there seems to be a single relation of cause in these sciences - pluralism about causality will not do either. Instead, we maintain, the health sciences require a theory (...)
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  40. Evidence‐Based Medicine and the Search for a Science of Clinical Care. [REVIEW]Kirstin Borgerson - 2006 - Isis 97:593-594.
  41. Kenneth W. Goodman: Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science. [REVIEW]Jason Grossman - 2004 - Philosophy of Science 71 (3):421-423.
  42. What is clinical effectiveness?Richard Ashcroft - 2002 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 33 (2):219-233.
    Clinical trials and other forms of evaluation of medical treatment are held to give an objective assessment of the ‘clinical effectiveness’ of the medical treatments under evaluation. This kind of evaluation is central to the evidence-based medicine movement, as it provides a basis for the rational selection of treatment. The ethical status of randomised clinical trials is widely agreed to depend crucially upon the state of equipoise regarding which of two (or more) treatments is more (or most) effective in a (...)
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  43. Visions of a Cure: Visualization, Clinical Trials, and Controversies in Cardiac Therapeutics, 1968-1998.David Jones - 2000 - Isis 91:504-541.
  44. Evidence-based and Evidence-free Generalisations: a Tale of Two Cultures.Raymond Tallis - 1999 - In David Fuller & Patricia Waugh (eds.), The Arts and Sciences of Criticism. Oxford University Press.
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  45. Scientific status of aromatherapy.J. R. King - 1994 - Perspectives in Biology and Medicine 37 (3):409.
  46. Reply to David Papineau.Peter Urbach - 1994 - British Journal for the Philosophy of Science 45 (2):712-715.
  47. Commentary: The Randomized Clinical Trial: For Whose Benefit?Arthur Schafer - 1985 - IRB: Ethics & Human Research 7 (2):4.
  48. Commentary on: Tone Kvernbekk's "Evidence-based practice , means-end reasoning and goal directed theories".Tracy Bowell - unknown