Philosophy and Methodology of Medicine (1-3 June 2021)
Idea & Motivation
The claims of medicine have been supported by a wide variety of different methods, ranging from randomized controlled trials to expert judgement and mechanism-based reasoning. Miriam Solomon has therefore aptly characterized medicine in terms of a developing, untidy, methodological pluralism. But can philosophers help with this development? In recent years, philosophers of science have become increasingly interested in assessing the strengths and weaknesses of the various methods employed in medicine. Some have defended the methodological superiority of randomized controlled trials, or at least meta-analyses of such trials. Others have challenged this superiority by on the one hand stressing the weaknesses of such methods in terms of their internal or external validity, and on the other hand emphasising the strengths of alternative methods, including methods involving expert judgement and mechanistic evidence.
This online conference will bring together philosophers of science and medical methodologists in an attempt to make progress towards resolving these debates concerning the strengths and weaknesses of the various methods employed in medicine.
We welcome submissions of abstracts of no longer than one page (not including references) for thirty-minute talks on topics in the philosophy and methodology of medicine, including but not limited to:
- Causal inference in medicine
- Foundational issues in statistics in medicine
- Bias in medical inference
- Medical epistemology
- Multi-agent medical epistemology
- Mechanisms in medicine
- Analogy and extrapolation in medicine
- Expert judgement in medicine.
The conference will be preceded by a Summer School to introduce graduate students and others to the main themes in the debates.
Call for Abstracts
Upload an abstract (pdf) at https://easychair.org/conferences/?conf=phiandmethofmed21.
Length of abstract: Up to 1 page of text, references can go on Page 2.
The Easychair submission form also asks you to fill a field called ''abstract''. Just type ''N/A'' or similar.
Notifications sent 12th of March 2021.
The conference will be held online.
In order to register for the conference, please send an email to email@example.com with the subject line: Registration: Philosophy and Methodology of Medicine.
A registration covers all three days.
Registered participants are not required to attend all talks.
Summer School Program
01 June 2021
|09:40 - 10:00||Welcome|
|10:00 - 11:00||Bennett Holman: The Case against mechanistic evidence|
|11:00 - 11:15||Coffee Break|
|11:15 - 12:15||Elena Rocca: Dispositions and causal evidence in medicine|
|12:15 - 13:45||Lunch Break|
|13:45 - 14:45||Federica Russo: The 'lifeworld’ of health and disease and the design of public health interventions|
|14:45 - 15:00||Coffee Break|
|15:00 - 16:00||David Teira and C. Uzcanga: Clean Data on a Cholera Vaccine: Jaime Ferrán's Submissions to the Prix Bréant|
Day 1 (02 June 2021)
|09:40 - 10:00||Welcome|
|10:00 - 10:50||Federica Russo: The epistemic values at work in epidemiology and public health|
|10:50 - 11:30||Michaela Egli: Buying external validity at the expense of internal validity: A deal with the devil?|
|11:30 - 11:40||Coffee Break|
|11:40 - 12:20||Charles Beasley: Replication and the medical sciences: a pluralist approach|
|12:20 -13:00||Saana Jukola: Bodies of Evidence - Determining the Cause of Death and the Problem of Underdetermination|
|13:00 - 14:00||Lunch Break|
|14:00 - 14:40||Sahanika Ratnayake: Epistemic Hypocrisy and the Evaluation of Talking Therapy via Evidence Based Medicine|
|14:40 - 15:20||Marina Di Marco: Variable Values: Causal Economy and Proportionality in Medicine|
|15:20 - 15:30||Coffee Break|
|15:30 - 16:10||Jonathan Fuller: Therapeutic Skepticism|
|16:10 - 16:15||Jonathan Fuller: The Launch of Philosophy of Medicine|
Day 2 (03 June 2021)
|10:00 - 10:50||Bennett Holman and Torsten Wilholt: The New Demarcation Problem|
|10:50 - 11:00||Coffee Break|
|11:00 - 11:40||Roberto Fumagalli: We Should Not Use Randomization Procedures to Allocate Scarce Life-Saving Resources|
|11:40 - 12:20||Sepehr Ehsani: Principled Mechanistic Explanations in Biology: A Case Study of Alzheimer's Disease|
|12:20 - 13:20||Lunch Break|
|13:20 - 14:10||Elena Rocca and S. P. Gonzalez: Mechanistic knowledge and clinical reasoning|
|14:10 - 14:50||Cj Blunt: A ranking of qualitative evidence?|
|14:50 - 15:00||Coffee Break|
|15:00 - 15:40||Benjamin Chin-Yee: On the Uses and Abuses of Biomarkers in Clinical Judgement|
|15:40 - 16:30||David Teira, N. Tempini and D. Fraile: The Trade-Off Between Impartiality and Freedom in the 21st Century Cures Act|
The task of this paper is three-fold. First, to evaluate recent accounts of replication with the intention of showing their limitations when applied to the medical sciences. Second, to put forward and defend a more promising account that I call replication pluralism, which I will argue is well situated to bring out the deep conceptual links between hypothesis, experiment, and replication. And third, to spell out the implications this account has for evaluating the so-called replication crisis in the medical sciences. In section (1) I introduce the dominant concepts of replication that have featured in the evaluation of the replication crisis over the past ten years. I then introduce two recent accounts of replication—the diagnostic and the resampling accounts—and argue that they should be rejected because they are both too restrictive and too permissive in what they count as a replication to serve as adequate models of replication in the medical sciences. This means that in application they will result in evidence that is all things considered less reliable. Then, In section (2) I introduce replication pluralism. I begin by disambiguating pluralism in this context and highlight three aspect of replication that one could be pluralist about: the content of a replication, the structure of replication, and the normative practice of replication. I then specify the claim of replication pluralism and show that the account is better suited to deal with cases that posed problems for the previous accounts. Finally, I argue that replication in practice reflects the pluralist account that I have laid out and that this should continue being the case. In section (3) I show how adopting a pluralist approach to replication dissolves many of the issues that arise in the evaluation of the replication crisis in the medical sciences. Section (4) concludes.
This abstract is available as PDF file: Abstract Blunt (177kb).
For this talk there is no abstract available.
This abstract is available as PDF file: Abstract DiMarco (90kb).
This abstract is available as PDF file: Abstract Egli (136kb).
This abstract is available as PDF file: Abstract Ehsani (110kb).
This abstract is available as PDF file: Abstract Fuller (78kb).
In the recent literature across philosophy, medicine and public policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that none of those arguments justifies using randomization procedures to allocate scarce life-saving resources and that the relevant decision makers should allocate scarce life-saving resources directly to the individuals with the strongest claims to these resources rather than use randomization procedures to allocate such resources.
Arguments that medical decision making should rely on a variety of evidence often begin from the claim that meta-analysis has been shown to be problematic. In this talk, I first examine Stegenga's (2011) argument that meta-analysis requires multiple decisions and thus fails to provide an objective ground for medical decision making. Next I will I examine the debate on mechanistic evidence and then reevaluate a canonical case study in this debate. I show that for the assessment of actual evidence, produced in a world that is far from ideal, omission of the social aspects of medical epistemology (e.g. commercial drivers of medical research) leads philosophers to draw the wrong lessons from cases they take as paradigmatic cases for their views. I close by suggesting one reason why it may be pragmatically rational to violate the principle of total evidence and by outlining the criteria for a successful argument against meta-analysis. A set of criteria I contend remain unmet.
There is now a general consensus amongst philosophers of science that values necessarily play a role in core areas of scientific inquiry. We argue that attention should now be turned from debating the value-free ideal to delineating legitimate from illegitimate influences of values in science, a project we dub “The New Demarcation Problem.” First, we review past attempts to demarcate the uses of values and propose a categorization of the strategies by where they seek to draw legitimacy from. Next, we propose a set of desiderata for what we take to be a satisfactory solution and present a case study where conflicting sets of values clearly impinge on science, but where the legitimacy of their influence is not. We use these desiderata and the case study--of the controversy around birth defects and their relation to the use of Hormone Pregnancy Tests--to illustrate what we take to be the strengths and weaknesses of current demarcation strategies. To be clear our goal is not to answer the question we pose, but to articulate a framework within which a solution can be judged.
This abstract is available as PDF file: Abstract Jukola (160kb).
This abstract is available as PDF file: Abstract Ratnayake (35kb).
This lecture explores the question of how evidential pluralism in medicine and public health should look in practice. We might accept the argument that rule-based approaches to evidence evaluation, such as the pyramid of evidence found in evidence-based medicine, lack completeness because they might exclude evidence that is particularly relevant for a specific case, on the basis of a general rule. However, once we exclude pyramids of evidence and we embrace evidential pluralism, we are also left with the open question of how useful the various methods are for the causal inquiry. How should different types of causal evidence be evaluated? In particular, when different types of evidence point to different results, which one should we prioritize? This lecture proposes a constructive, practical answer based on the conceptual, philosophical tradition that highlights intrinsic properties (dispositions, causal powers or capacities) as essential features of causality. If we assume that medicine is about uncovering intrinsic dispositions, this abstract idea has wide methodological implications. We will see how different methods, such as lab experiments, case studies, N-of-1 trials, case control studies, cohort studies, RCTs and patient narratives, all have some strengths and some limitations for picking out intrinsic causal properties. This way, I will explain why considering philosophy of causality is crucial for evaluating causality in the health sciences. The various methods will be then organized in a temporal process, which could then take us from an observed phenomenon (e.g., a correlation) to a causal hypothesis and, finally, to improved theoretical knowledge.
Traditionally, understanding biological mechanisms has had a central role in clinical reasoning. With the raise of the evidence-based paradigm, however, such role has been under debate. On one hand, evidence of pathophysiological mechanisms has been de-emphasised in clinical guidelines. This is often motivated by the unreliability of our understanding of complex biological mechanisms. On the other hand, evidence of mechanisms has been defended by some scholars as key to clinical practice. Here, we differentiate the role of evidence from biological mechanisms in two types of clinical predictions: predictions about safety and predictions about efficacy of a certain intervention for the particular patient. Further on, for each type of prediction we analyse separately two roles that evidence of mechanisms might have, confirming of disconfirming, depending on whether or not evidence of mechanism supports that a result from clinical studies or epidemiological evidence will apply to the single patient. We conclude that the ‘unreliability because of incompleteness’ argument against the emphasis on mechanistic clinical thinking only applies to some of the considered cases. We conclude by offering a model for a more granular view of the role of mechanistic thinking clinical predictions.
Federica Russo (Amsterdam): School Lecture: The 'lifeworld’ of health and disease and the design of public health interventions - with M.Kelly
In the middle of the severest public health crisis of the 21st century, we are encouraged to to reflect even more deeply er about the nature of health and disease, and about how to design and implement effective public health interventions. For numerous diseases and conditions, as well as for Covid-19, our knowledge base is rich. We know a lot about the biology of the disease, and we have plenty of statistics that relate health to socio-economic factors. In this paper we argue that we need to add a third dimension to this knowledge base, namely a thorough description of the lifeworld of health and disease, and of the mixed bio-social mechanisms that operate in it. We present the concepts of lifeworld and of mixed mechanisms, and then illustrate how they can be operationalized and measured. Finally, we explain their complementarity with the biological and statistical dimensions of health and disease for the design of public health interventions.
Federica Russo (Amsterdam): Conference Talk: The epistemic values at work in epidemiology and public health - with M. Kelly
The current pandemic has led scholars in the humanities and health and social sciences to accelerate their reflections about public health, its evidence base, its normative dimensions, as well as its successes, failures and pitfalls. In this paper, we aim to contribute to this global thinking about public health by focusing on one particular aspect, namely its dependence on epidemiology as the main generator of evidence for public health interventions and policy. Our argument is that while it is undeniable that epidemiology (and its sub-fields) have made very many significant contributions both to enlarge our knowledge of disease and its causation, prevalence and incidence and to channel public health interventions, it also has its limits. The limitations of epidemiology lie in the (implicit) epistemic assumptions which involve focusing on (aggregates of) individuals and obscures the key role of the social level of analysis. These limitations, however, are also an opportunity to highlight and rethink a more distinctly social approach to health and disease, and one that is genuinely population in character.
Historians of statistics have mostly focused on the techniques for data analysis that allowed the assessment of medical treatments, but not so much on the organization of the very data about treatment effects and its epistemic standing. Our paper is about the value of raw data in articulating clinical judgment. We analyse Jaime Ferrán’s three submissions to the Prix Bréant awarded by the French Academy of Sciences to incentivize research on cholera. Ferrán, a Spanish independent physician, claimed to have discovered a vaccine in 1884. He tried on thousands of patients during the cholera outburst in Valencia the following year. His trial sparked a controversy in Spain and abroad on the vaccine’s efficacy. Several interpreters have accused the Academy of bias for not recognizing Ferrán’s success with the Bréant. Drawing on the archival records of the award, we suggest that Ferrán failed instead to provide evidence formatted in a way that conformed to the emerging standards for data presentation at the Academy.
Randomized controlled trials test the safety and efficacy of new drugs with a number of default debiasing devices. Controls such as randomization and blinding prevent the participants from manipulating the trial according to their interest. In this regard, controls guarantee a degree of impartiality in the test. But the trial participants often do not like controls, arguing that they impose a paternalist constraint on their legitimate preferences. The 21st Century Cures Act, passed by the US Congress in 2016, invites the Food and Drug Administration to use some alternative testing methods for regulatory purposes, in which the participants’ preferences are somehow incorporated. In this context, we discuss in a historical perspective the trade-off between trial impartiality and the participants’ freedom in regulatory tests. We argue that the only way out of this trade-off is considering which methods actually improve upon the performance of conventional trials in keeping dangerous or ineffective compounds out of pharmaceutical markets.