Inference to the best explanation as a theory for the quality of mechanistic evidence in medicine

Original Paper in Philosophy of Science


Inference to the Best Explanation (IBE) is usually employed in the Scientific Realism debates. As far as particular scientific theories are concerned, its most ready usage seems to be that of a theory of confirmation. There are however more uses of IBE, namely as an epistemological theory of testimony and as a means of categorising and justifying the sources of evidence. In this paper, I will present, develop and exemplify IBE as a theory of the quality of evidence - taking examples from medicine and showing that IBE can thereby provide the epistemological underpinning and justify the criteria of grading quality of mechanistic evidence that have been recently provided in the Clarke et al. (2014) paper on how evidence of medical mechanisms is to be construed alongside population studies.


Inference to the best explanation Mechanisms Medical causation Testimony Quality of evidence 



This article was written as part of the project ‘Grading Evidence of Mechanisms in Physics and Biology’, funded by the Leverh ulme Trust ( I have received useful comments from Kristoffer Ahlstrom-Vij, Rachel Cooper, Veli-Pekka Parkkinen, Jon Williamson, and three anonymous referees for this journal.


  1. Adler, J. (2012). Epistemological problems of testimony. Stanford Encyclopedia of Philosophy.
  2. Audi, R. (1997). The place of testimony in the fabric of knowledge and justification. American Philosophical Quarterly, 34, 405–422.Google Scholar
  3. Bird, A. (2010). Eliminative abduction—examples from medicine. Studies in History and Philosophy of Science, 4, 345–352.CrossRefGoogle Scholar
  4. Bird, A. (2011). The epistemological function of Hill’s criteria. Preventive Medicine, 53, 85–96.CrossRefGoogle Scholar
  5. Bovens, L., & Hartmann, S. (2003). Bayesian epistemology. Oxford: Clarendon Press.Google Scholar
  6. Braunwald, E., & Chidsey, C. A. (1965). The adrenergic nervous system in the control of the normal and failing heart. Proceedings of the Royal Society of Medicine, 58(12), 1063–1066.Google Scholar
  7. Cartwright, N. (1989). Nature’s capacities and their measurement. Oxford: Oxford University Press.Google Scholar
  8. Clarke, B., Gillies, D., Illari, P., Russo, F., & Williamson, J. (2014). Mechanisms and the evidence hierarchy. Topoi, 33(2), 339–360.CrossRefGoogle Scholar
  9. Darsee, J. (1983). A retraction of two papers on cardiomyopathy. The New England Journal of Medicine, 308, 1419.Google Scholar
  10. Douven, I. (2016). Inference to the best explanation: What Is It? And Why Should We Care? In K. McCain & T. Poston (Eds.), Best explanations: new essays on inference to the best explanation. Oxford: Oxford University Press.Google Scholar
  11. Douven, I., & Schupbach, J. (2015a). Probabilistic alternatives to Bayesianism: the case of explanationism. Frontiers in Psychology, 6, 459.CrossRefGoogle Scholar
  12. Douven, I., & Schupbach, J. (2015b). The role of explanatory considerations in updating. Cognition, 142, 299–311.CrossRefGoogle Scholar
  13. Douven, I., and S. Wenmackers. (2015). Inference to the best explanation versus Bayes’s rule in a social setting. British Journal for the Philosophy of Science, Online first. Accessed 8 March 2016.
  14. Dragulinescu, S. (2012). On ‘Stabilising’ medical mechanisms, truth-makers and epistemic causality: a critique to Williamson and Russo’s approach. Synthese, 187(2), 785–800.Google Scholar
  15. Dragulinescu, S. (2016a). Inference to the best explanation and mechanisms in medicine. Theoretical Medicine and Bioethics, 37(3), 211–232.Google Scholar
  16. Dragulinescu, S. (2016b). Mechanisms and difference-making. Acta Analytica. doi: 10.1007/s12136-016-0292-1.
  17. Epstein, S., Robinson, B. F., Kahler, R. L., & Braunwald, E. (1965). Effects of beta-adrenergic blockade on the cardiac response to maximal and submaximal exercise in man. The Journal of Clinical Investigation, 44(11), 1745–1753.CrossRefGoogle Scholar
  18. Feldman, M. D., Copelas, L., Gwathmey, J. K., Phillips, P., Warren, S. E., Schoen, F., Grossman, W., & Morgan, J. P. (1987). Deficient production of cyclic AMP: pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure. Circulation, 75, 331.CrossRefGoogle Scholar
  19. Gaffney, T., & Braunwald, E. (1963). Importance of the adrenergic nervous system in the support of circulatory function in patients with congestive heart failure. The American Journal of Medicine, 34, 320–324.CrossRefGoogle Scholar
  20. Gelfert, A. (2010). Reconsidering the role of inference to the best explanation in the epistemology of testimony. Studies in History and Philosophy of Science Part A, 41(4), 386–396.CrossRefGoogle Scholar
  21. Glass, D. (2012). Inference to the best explanation: does it track truth? Synthese, 185, 411–427.CrossRefGoogle Scholar
  22. Graham, P. J. (2006). Testimonial justification: inferential or non-inferential. Philological Quarterly, 56, 84–95.Google Scholar
  23. Harman, G. (1965). The inference to the best explanation. The Philosophical Review, 74, 88–95.CrossRefGoogle Scholar
  24. Hempel, C. G. (1970). On the ‘Standard Conception’ of scientific theories. In M. Radner & S. Winokur (Eds.), Minnesota studies in the philosophy of science (Vol. Vol. IV, pp. 142–163). Minneapolis: University of Minnesota Press.Google Scholar
  25. Hempel, C. G., & Oppenheim, P. (1948). Studies in the logic of explanation. Philosophy of Science, 15, 135–175.CrossRefGoogle Scholar
  26. Hernandez, et al. (2009). Clinical effectiveness of Beta-blockers in heart failure. Journal of the American College of Cardiology, 53(2), 184–192.CrossRefGoogle Scholar
  27. Hume, D. (1977) [1748]. An Enquiry concerning human understanding. Eric Steinberg (ed.). Indianapolis: Hackett Publishing Company.Google Scholar
  28. Illari, P., & Williamson, J. (2012). What is a mechanism: thinking about mechanisms across the sciences. European Journal for Philosophy of Science, 2, 119–135.CrossRefGoogle Scholar
  29. Lackey, J. (2006). It takes two to tango: beyond reductionism and non-reductionism in the epistemology of testimony. In J. Lackey & E. Sosa (Eds.), The epistemology of testimony. Oxford University Press.Google Scholar
  30. Lackey, J. (2008). Learning from words. Oxford: Oxford University Press.CrossRefGoogle Scholar
  31. Landau, M. (2012). An Interview with Dr. Eugene Braunwald. Clinical Chemistry, 58(1), 11–20.CrossRefGoogle Scholar
  32. Lee, T. (2013). Eugene Braunwald and the rise of modern medicine. Harvard University PressGoogle Scholar
  33. Lipton, P. (1993). Making a difference. Philosophica, 51, 39–54.Google Scholar
  34. Lipton, P. (1994). Truth, existence, and the best explanation. In A. A. Derksen (ed.), The scientific realism of rom Harré. Tilburg University PressGoogle Scholar
  35. Lipton, P. (1998). The epistemology of testimony. Studies in History and Philosophy of Science, 29, 1–31.CrossRefGoogle Scholar
  36. Lipton, P. (2000). Inference to the best explanation. In W.H. Newton-Smith (Ed.), A companion to the philosophy of science (pp. 184–193). Maalden: Blackwell.Google Scholar
  37. Lipton, P. (2001). Is explanation a guide to inference? A reply to Wesley C. Salmon. In G. Hon & S. Rakover (Eds.), Explanation, theoretical approaches and applications (pp. 93–120). Dordrecht: Springer.Google Scholar
  38. Lipton, P. (2004). Inference to the best explanation (second ed.). London: Routledge.Google Scholar
  39. Lipton, P. (2007). Alien abduction: Inference to the best explanation and the management of testimony. Episteme, 4(3), 238–251.CrossRefGoogle Scholar
  40. Mann, D., & Bristow, M. (2005). Mechanisms and models in heart failure. The biomechanical model and beyond. Circulation, 111(21), 2837–2849.CrossRefGoogle Scholar
  41. McCain, K., & Poston, T. (2014). Why explanatoriness is evidentially relevant. Thought, 3(2), 145–153.Google Scholar
  42. McMullin, E. (1992). The inference that makes science. Milwaukee: Marquette University Press.Google Scholar
  43. Mill, JS [1843] (2002). A system of logic. Honolulu: University Press of the Pacific.Google Scholar
  44. Niiniluoto, I. (1999). Defending abduction. Philosophy of Science, 66, S436–S451.CrossRefGoogle Scholar
  45. Niiniluoto, I. (2007). Abduction and scientific realism. In F. Keskin (Ed.), The proceedings of the twenty-first world congress of philosophy, vol. 12: Philosophical trends in the XXth Century (pp. 137–142). Ankara: Philosophical Society of Turkey.Google Scholar
  46. Perrine, T. (2014). In defense of non-reductionism in the epistemology of testimony. Synthese, 191(14), 3227–3237.CrossRefGoogle Scholar
  47. Psillos, S. (1999). Scientific realism: how science tracks truth. London: Routledge.Google Scholar
  48. Psillos, S. (2000). Abduction: between conceptual richness and computational complexity. In A. C. Kakas & P. Flach (Eds.), Abduction and induction: essays in their relation and integration (pp. 59–74). Dordrecht: Kluwer.CrossRefGoogle Scholar
  49. Psillos, S. (2002). Simply the best: a case for abduction. In A. C. Kakas & F. Sadri (Eds.), Computational logic: from logic programming into the future (pp. 605–625). Dordrecht: Springer.CrossRefGoogle Scholar
  50. Relman, A. (1983). Lessons from the Darsee affair. The New England Journal of Medicine, 308(23), 1415–1417.CrossRefGoogle Scholar
  51. Russo, F., & Williamson, J. (2007). Interpreting causality in the health sciences. International Studies in the Philosophy of Science, 21(2), 157–170.CrossRefGoogle Scholar
  52. Russo, F., & Williamson, J. (2011). Epistemic causality and evidence-based medicine. History and Philosophy of the Life Sciences, 33(4), 563–582.Google Scholar
  53. Schurz, G. (2008). Patterns of abduction. Synthese, 164(2), 201–234.CrossRefGoogle Scholar
  54. Swedberg, K. (1993). Initial experience with Beta blockers in dilated cardiomyopathy. The American Journal of Cardiology, 71(9), 30C–38C.CrossRefGoogle Scholar
  55. Waagstein, F. (2002). Beta-blockers in congestive heart failure: the evolution of a new treatment concept – mechanisms of action and clinical implications. Journal of Clinical and Basic Cardiology, 5(3), 215–223.Google Scholar
  56. Waagstein, F., Hjalmarson, A., Varnauskas, E., & Wallentin, I. (1975). Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. British Heart Journal, 37(10), 1022–1036.CrossRefGoogle Scholar
  57. Wilmshurst, P. (2007). Dishonesty in medical research. The Medico-Legal Journal, 75(1), 3–12.CrossRefGoogle Scholar
  58. Woodward. (2002). What is a Mechanism: A Counterfactual Account. Philosophy of Science 69, supplement. Proceedings of the 2000 Biennial meeting of the philosophy of science association. Part II: Symposia Papers: S366–S377.Google Scholar
  59. Woodward (2011). Mechanisms revisited. Synthese, 83, 409–427.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Philosophy DepartmentUniversity of KentCanterburyUK

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