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Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections (...) between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink) | |
There are two competing views regarding the role of mechanistic knowledge in inferences about the effectiveness of interventions. One view holds that inferences about the effectiveness of interventions should be based only on data from population-level studies (often statistical evidence from randomised trials). The other view holds that such inferences must be based in part on mechanistic evidence. The competing views are local principles of inference, the plausibility of which can be assessed by a more general normative principle of inference. (...) Bayesianism tells us to base inferences on both the ‘likelihood’ and the ‘prior’. The likelihood represents statistical evidence. One influence on the prior probability of a hypothesis like ‘d causes x’ is mechanistic knowledge of how d causes x. Thus, reasoning about such inferences by appealing to both statistical and mechanistic evidence is vindicated by our best general theory of inference. The primary contribution of this paper is to assess the merits and weaknesses of the arguments on both sides of the debate, using the Bayesian framework. This analysis lends support to those who argue that we should base our causal inferences about interventions in part on mechanistic evidence. (shrink) | |
The current strategy of searching for an effective treatment for COVID-19 relies mainly on repurposing existing therapies developed to target other diseases. Conflicting results have emerged in regard to the efficacy of several tested compounds but later results were negative. The number of conducted and ongoing trials and the urgent need for a treatment pose the risk that false-positive results will be incorrectly interpreted as evidence for treatments’ efficacy and a ground for drug approval. Our purpose is twofold. First, we (...) show that the number of drug-repurposing trials can explain the false-positive results. Second, we assess the evidence for treatments’ efficacy from the perspective of evidential pluralism and argue that considering mechanistic evidence is particularly needed in cases when the evidence from clinical trials is conflicting or of low quality. Our analysis is an application of the program of Evidence Based Medicine Plus to the drug repurposing trials for COVID. Our study shows that if decision-makers applied EBM+, authorizing the use of ineffective treatments would be less likely. We analyze the example of trials assessing the efficacy of hydroxychloroquine as a treatment for COVID-19 and mechanistic evidence in favor of and against its therapeutic power to draw a lesson for decision-makers and drug agencies on how excessive hypothesis testing can lead to spurious findings and how studying negative mechanistic evidence can be helpful in discriminating genuine from spurious results. (shrink) | |
What are the roles of scientific causal knowledge in relation to the evidential requirements of policy making? In this chapter, I review the existing approaches in philosophy of science to the policy relevance of causal knowledge. I assess the specific concerns and questions on which these philosophical accounts have focused and show how they only offer a partial perspective of the relation between causal knowledge and policy making. Most existing views are top-down approaches: they start from philosophical concerns about causation (...) and evidence, and then make general claims about (potential) policy implications, but leave the notion of “policy” unanalyzed. As an alternative, I put forward some ideas toward a bottom-up approach: one that understands policy making as a dynamic process with several stages, and that starts from concrete policy problems, to then examine how causal notions and methods can contribute in various ways to the specifics of the process of policy making. (shrink) | |
The experimental revolution in the social sciences is one of the most significant methodological shifts undergone by the field since the ‘quantitative revolution’ in the nineteenth century. One of the often valued features of social science experimentation is precisely the fact that there are clear methodological rules regarding hypothesis testing that come from the methods of the natural sciences and from the methodology of RCTs in the biomedical sciences, and that allow for the adjudication among contentious causal claims. We examine (...) critically this claim and argue that some current understandings of the practices that surround social science experimentation overestimate the degree to which experiments can actually fulfil this role as “objective” adjudicators, by neglecting the importance of shared background knowledge or assumptions and of consensus regarding the validity of the constructs involved in an experiment. We take issue with the way the distinction between internal and external validity is often used to comment on the inferential import of experiments, used both among practitioners and among philosophers of science. We describe the ways in which the more common use of the internal/external distinction differs from Cook and Campbell’s original methodological project, in which construct validity and the four-fold validity typology were all important in assessing the inferential import of experiments. We argue that the current uses of the labels internal and external, as applied to experimental validity, help to encroach a simplistic view on the inferential import of experiments that, in turn, misrepresents their capacity to provide objective knowledge about the causal relations between variables. (shrink) No categories | |
The history of economic thought witnessed several prominent economists who took seriously models and concepts in physics for the elucidation and prediction of economic phenomena. Econophysics is an emerging discipline at the intersection of heterodox economics and the physics of complex systems, with practitioners typically engaged in two overlapping but distinct methodological programs. The first is to export mathematical methods used in physics for the purposes of studying economic phenomena. The second is to export mechanisms in physics into economics. A (...) conclusion is drawn that physics transfer is often justified at the level of mathematical transfer but unjustified at the level of mechanistic transfer. (shrink) | |
There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink) | |
The aim of this article is to question the epistemic presuppositions of applying behavioural science in public policymaking. Philosophers of science who have examined the recent applications of the behavioural sciences to policy have contributed to discussions on causation, evidence, and randomised controlled trials. These have focused on epistemological and methodological questions about the reliability of scientific evidence and the conditions under which we can predict that a policy informed by behavioural research will achieve the policymakers’ goals. This paper argues (...) that the philosophical work of Helen Longino can also help us to have a better and fuller understanding of the knowledge which the behavioural sciences provide. The paper advances an analysis of the knowledge claims that are made in the context of policy applications of behavioural science and compares them with the behavioural research on which they are based. This allows us to show that behavioural policy and the debates accompanying it are based on an oversimplified understanding of what knowledge behavioural science actually provides. Recognising this problem is important as arguments that justify reliance on the behavioural sciences in policy typically presume this simplification. (shrink) No categories | |
This article argues that nudges can often be turned into self-nudges: empowering interventions that enable people to design and structure their own decision environments—that is, to act as citizen choice architects. Self-nudging applies insights from behavioral science in a way that is practicable and cost-effective but that sidesteps concerns about paternalism or manipulation. It has the potential to expand the scope of application of behavioral insights from the public to the personal sphere (e.g., homes, offices, families). It is a tool (...) for reducing failures of self-control and enhancing personal autonomy; specifically, self-nudging can mean designing one’s proximate choice architecture to alleviate the effects of self-control problems, engaging in education to understand the nature and causes of self-control problems and employing simple educational nudges to improve goal attainment in various domains. It can even mean self-paternalistic interventions such as winnowing down one’s choice set by, for instance, removing options. Policy makers could promote self-nudging by sharing knowledge about nudges and how they work. The ultimate goal of the self-nudging approach is to enable citizen choice architects’ efficient self-governance, where reasonable, and the self-determined arbitration of conflicts between their mutually exclusive goals and preferences. (shrink) | |
The existing philosophical views on what is the meaning of causality adequate to medicine are vastly divided. We approach this question and offer two arguments in favor of pluralism regarding concepts of causality. First, we analyze the three main types of research designs (randomized-controlled trials, observational epidemiology and laboratory research). We argue, using examples, that they allow for making causal conclusions that are best understood differently in each case (in agreement with a version of manipulationist, probabilistic and mechanistic definitions, respectively). (...) Second, we analyze clinical practice and argue that these manipulationist, probabilistic and mechanistic causal claims can be used as evidence for different therapeutic decisions. We differentiate among ‘predicting’ that does not change the relata of causal claims, (mechanistic) ‘interferences’, and ‘interventions’ in the strict sense that act on causes to change effects. The central conclusion is that causal claims agreeing with diverse concepts of causality can deliver evidence for different types of therapeutic decisions. (shrink) | |
We argue that behavioural public policies (BPP) should be categorized by the kind of mechanism through which they operate, not by the kind of treatment they implement. Reviewing the energy consumption BPP literature, we argue (i) that BPPs are currently categorized by treatment; (ii) that treatment-based categories are subject to mechanistic heterogeneity: there is substantial variation of mechanisms within each treatment type; and (iii) that they also display mechanistic overlap: there is substantial overlap between mechanisms across treatment types. Consequently, current (...) categorizations of BPPs do not reveal the conditions of their efficacy and should be revised to better reflect mechanistic information. (shrink) | |
The US Food and Drug Administration (FDA) is fraught with controversies over the role of values and politics in regulatory science, especially with drugs in the realm of reproductive health. Philosophers and science studies scholars have investigated the ways in which social context shapes medical knowledge through value judgments, and feminist scholars and activists have criticized sexism and injustice in reproductive medicine. Nonetheless, there has been no systematic study of values and gender norms in FDA drug regulation. I focus on (...) three questions about values in regulatory science. First, how have societal values and gender norms shaped the way that the FDA regulates drugs in the realm of reproductive health, specifically with drug labels? Second, what are the ethical, epistemic, and social consequences of these influences on regulation for women and other marginalized groups? Third, which societal values and gender norms ought to influence drug regulation about reproductive health, and how ought this happen? Integrating philosophical analysis with historical archival research and in-depth interviews, I conduct three case studies of drug labeling about reproductive health: (1) the “drug fact” about the mechanism of the morning-after pill; (2) the package inserts for patients about the health risks of oral contraceptives; and (3) the special physician labels made for prescribing drugs to pregnant women. I identify three challenges for the FDA and suggest ways to reduce the influence of sexist values and facilitate feminist alternatives. First, across these cases, I have found that there are many ways in which other concerns in reproductive medicine (such as zygotic life, fetal health, and population control) have devalued women’s health. Second, both knowledge and ignorance xvi about their reproductive health have contributed to women’s oppression, especially poor women and women of color. Finally, by avoiding the epistemic dimensions of ethics, powerful, mostly male parties in medicine (such as doctors, pharmaceutical companies, and religious institutions) have misused “informed consent,” “religious freedom,” and “paternalism” for unethical purposes. For improvement, I suggest extracting sexist values and gender norms from regulatory science that cause epistemic injustices, and I point to success stories for reforming sexism with feminism at the FDA. (shrink) | |
The aim of this paper is to reconstruct and critically assess the evidential relationship between neuroscience and educational practice. To do this, I reconstruct a standard way in which evidence from neuroscience is used to support recommendations about educational practice, that is, testing pedagogical interventions using neuroimaging methods, and discuss and critically assess the inference behind this approach. I argue that this inference rests on problematic assumptions, and, therefore, that neuroimaging intervention studies have no special evidential status for basing educational (...) practice. I conclude arguing that these limitations could be resolved by integrating evidence from neurocognitive and educational science. (shrink) |
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