While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in a (...) pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)

Clinical research must be understood to be the foundation of scientific medicine of the clinical type. But the essence of scientific clinical medicine remains a matter of profound confusion, even in clinical academia, and so does the essence of clinical research. The confusion now revolves, principally, around ‘clinical epidemiology’. We address clinical research in the meaning of quintessentially ‘applied’ clinical research, which we take to be the foundation of the scientific knowledge base of clinical medicine, of gnosis (dia‐, etio‐, pro‐) (...) in it. More specifically, we address the essence, priorities, and status quo of this research – and argue that the requisite theory of this is not a matter of ‘clinical epidemiology’ but of theory of clinical research endogenous to clinical (rather than epidemiological) academia. (shrink)

We suggest that human culture exhibits key Darwinian evolutionary properties, and argue that the structure of a science of cultural evolution should share fundamental features with the structure of the science of biological evolution. This latter claim is tested by outlining the methods and approaches employed by the principal subdisciplines of evolutionary biology and assessing whether there is an existing or potential corresponding approach to the study of cultural evolution. Existing approaches within anthropology and archaeology demonstrate a good match with (...) the macroevolutionary methods of systematics, paleobiology, and biogeography, whereas mathematical models derived from population genetics have been successfully developed to study cultural microevolution. Much potential exists for experimental simulations and field studies of cultural microevolution, where there are opportunities to borrow further methods and hypotheses from biology. Potential also exists for the cultural equivalent of molecular genetics in “social cognitive neuroscience,” although many fundamental issues have yet to be resolved. It is argued that studying culture within a unifying evolutionary framework has the potential to integrate a number of separate disciplines within the social sciences. (shrink)

Claude Bernard, the father of scientific physiology, believed that if medicine was to become truly scientiifc, it would have to be based on rigorous and controlled animal experiments. Bernard instituted a paradigm which has shaped physiological practice for most of the twentieth century. ln this paper we examine how Bernards commitment to hypothetico-deductivism and determinism led to (a) his rejection of the theory of evolution; (b) his minima/ization of the role of clinical medicine and epidemiological studies; and (c) his conclusion (...) that experiments on nonhuman animals were, "entirely conclusive for the toxicology and hygiene of man". We examine some negative consequences of Bernardianism for twentieth century medicine, and argue that physio/ogy's continued adherence to Bernardianism has caused it to diverge from the other biological sciences which have become increasingly infused with evolutionary theory. (shrink)

It is considered in some quarters that hypothesis‐driven methods are the only valuable, reliable or significant means of scientific advance. Data‐driven or ‘inductive’ advances in scientific knowledge are then seen as marginal, irrelevant, insecure or wrong‐headed, while the development of technology—which is not of itself ‘hypothesis‐led’ (beyond the recognition that such tools might be of value)—must be seen as equally irrelevant to the hypothetico‐deductive scientific agenda. We argue here that data‐ and technology‐driven programmes are not alternatives to hypothesis‐led studies in (...) scientific knowledge discovery but are complementary and iterative partners with them. Many fields are data‐rich but hypothesis‐poor. Here, computational methods of data analysis, which may be automated, provide the means of generating novel hypotheses, especially in the post‐genomic era. BioEssays 26:99–105, 2004. © 2003 Wiley Periodicals, Inc. (shrink)

Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: Males are more frequently afflicted, (...) females more severely; disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research. (shrink)

In recent decades, postmodernists and sociologists of science have argued that science is just one of many human activities with social and political aims -- comparable to, say, religion or art. They have questioned the objectivity of science, and whether it has any unique ability to find the truth. Not surprisingly, such claims have evoked a negative response from proponents of the traditional view of science; the debate between the two sides has been called the science wars. In the debate, (...) scientists have made few attempts to meet the postmodern critique on its own grounds, through serious reflection on the everyday practice of science. Yet that is the only way to understand the nature of science and the features that distinguish science from other activities. (shrink)

Following the development of the selectionist theory of the immune system, there was an attempt to characterise many biological mechanisms as being ‘selectionist’ as juxtaposed with ‘instructionist’. However, this broad definition would group Darwinian evolution, the immune system, embryonic development, and Chomsky’s principles-and-parameters language-acquisition mechanism together under the ‘selectionist’ umbrella, even though Chomsky’s mechanism and embryonic development are significantly different from the selectionist mechanisms of biological evolution and the immune system. Surprisingly, there is an abstract way using two dual mathematical (...) logics to make the distinction between genuinely selectionist mechanisms and what are better called ‘generative’ or symmetry-breaking mechanisms. This distinction is outlined in this note. (shrink)

The article discusses Karl Popper’s account of Lamarckism. In this article I use Popper’s published and unpublished statements regarding Lamarckism as well as his correspondence with the Australian immunologist Edward Steele and other biologists to examine why Popper was interested in Lamarckism, how his account of Lamarckism can be understood in the context of his philosophy, and what, if any, new context Popper provided for the discussion of this abandoned doctrine. I begin by discussing Popper’s frame of reference regarding Lamarckism, (...) examining how it changed following his involvement with different “transitory groups” of biologists concerned with redefining the boundaries between traditional disciplines. I then discuss Popper’s account of Lamarckism in positioning it in relation to three aspects of his philosophy: his distinction between the principles of induction/instruction and deduction/selection, his distinction between scientific and teleological concepts, and his concept of progress in science. Then, I follow the debate concerning Steele’s Lamarckian experiments with a closer look at Popper’s role and his position in this controversy. I conclude that Popper’s writings provided a new context for the discussion of Lamarckism in the 1970s and 1980s, thus making it “scientifically acceptable” again. I preface this discussion by a brief outline of Steele’s Lamarckian hypothesis and Popper’s comments on Steele’s work. (shrink)

Discussions in neuroethics to date have ignored an ever-increasing neuroscientific lilterature on sex differences in brains. If, indeed, there are significant differences in the brains of men versus women and in the brains of boys versus girls, the ethical and social implications loom very large. I argue that recent neuroscientific findings on sex-based brain differences have significant implications for theories of morality and for our understandings of the neuroscience of moral cognition and behavior.

It has been argued that the fundamental laws of physics are deceitful in that they give the impression of greater unity and coherence in our theories than is actually found to be the case. Causal stories and phenomenological relationships are claimed to provide a more acceptable account of the world, and only theoretical entities — not laws — are considered as perhaps corresponding to real features of the world.This paper examines these claims in the light of the author's own field (...) of research: high energy physics. Some of the distinctions upon which the above conclusions are based are found not to be tenable in practice. Examples from experimental particle physics are presented which suggest an important role of the underlying theoretical structure which cannot be overlooked. It is argued that the fundamental theories must, in fact, be treated as being as worthy or unworthy of ontological commitment as the entities they postulate or the phenomenological relationships they inspire. Whilst it is conceded that aspects of the current theoretical formalism belie literal interpretation, it is maintained that revision in these particular areas need not affect the symmetry principles, particle spectra, or coupling strengths that largely determine the empirical content of the theory. (shrink)

Following the development of the selectionist theory of the immune system, there was an attempt to characterize many biological mechanisms as being "selectionist" as juxtaposed to "instructionist." But this broad definition would group Darwinian evolution, the immune system, embryonic development, and Chomsky's language-acquisition mechanism as all being "selectionist." Yet Chomsky's mechanism (and embryonic development) are significantly different from the selectionist mechanisms of biological evolution or the immune system. Surprisingly, there is a very abstract way using two dual mathematical logics to (...) make the distinction between genuinely selectionist mechanisms and what are better called "generative" mechanisms. This note outlines that distinction. (shrink)