Abstract
We advance a conception of evidence in medicine that accounts for the significance of randomized clinical trials despite the fact that they are not the gold standard in clinical research. Crucial to this account is the gradualist, partial nature of evidence in medicine, and the different kinds of uncertainty that are involved throughout medical inquiry.
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Notes
- 1.
This is not the place to provide a full defense of the neutrality norm, which bears on controversial issues regarding the connections between science and values (see, for instance, Lacey 1999; Mitchell 2004; Douglas 2009; Biddle 2013). But we argue below that violation of this norm has significant risks, which are better avoided.
- 2.
It is also a mistake to characterize data uncertainty as the same type of uncertainty that is treated by Jeffrey’s model of conditionalization since we are not attempting to characterize uncertainty about the evidential input but uncertainty about the evidential relevance relation. Jeffrey’s model of conditionalization makes it possible to accommodate uncertainty about the truth-value of an evidential input (by allowing it to take a value less than one) but the application of this model ultimately serves to collapse a distinction between uncertainty about the truth-value of the evidential input and uncertainty about the truth-value of the hypothesis. Again, when two distinct types of uncertainty are collapsed, we are often left with inadequate tools when attempting accurate reconstructions of the process of scientific inference in actual practice.
- 3.
What kind of object is then a piece of evidence? It is not clear that there is a unique answer to this question. Different things are invoked in different contexts as evidence. Different things have been—and can be—considered as evidence. A theory of evidence is monist if it admits only one kind of thing as being evidence. A theory of evidence is pluralist if it admits multiple kinds of things as being evidence. Given the diversity of sources of evidence in the sciences, not surprisingly, we favor a pluralist view. We don’t think, however, that this challenges the objectivity of evidence. After all, it’s not up to us what rules out (likely) alternatives that undermine the hypothesis under investigation. Thus, objectivity is preserved in face of this pluralism.
- 4.
This is, of course, a general issue. It is possible that the new population is different from the old regarding treatment efficacy; that is, although the results were perhaps generally correct, they did not apply to the new population. This is precisely an instance of experimental uncertainty at work.
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Acknowledgements
This work was funded by a grant from the Arsht Ethics Initiatives at the University of Miami Ethics Programs and made possible by a generous gift from philanthropist Adrienne Arsht. We are very grateful to the UM Ethics Programs and the Arsht Ethics Initiatives for their support. Thanks are also due to two reviewers for their extensive and very helpful comments on an earlier version of this paper, which led to substantial improvements.
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Bueno, O., Neiman, R. (2017). Partial Evidence in Medicine. In: Chao, HK., Reiss, J. (eds) Philosophy of Science in Practice. Synthese Library, vol 379. Springer, Cham. https://doi.org/10.1007/978-3-319-45532-7_3
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