Johannes Persson

In medical research, it is not unusual that risks are ruled out without any specification the exact risk that was ruled out. This makes it difficult to balance expected health benefits and risk of harm when choosing between alternative treatment options. International guidelines for reporting medical research results are sufficiently specific when it comes to establishing health benefits. However, there is a lack of standards for reporting on ruling out risks. We argue that transparency is needed, as in the case of non-inferiority trials. The Consolidated Standards of Reporting Trials and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements should be revised accordingly.

Do forest owners’ levels of education or value profiles explain their responses to climate change? The cultural cognition thesis has cast serious doubt on the familiar and often criticized "knowledge deficit" model, which says that laypeople are less concerned about climate change because they lack scientific knowledge. Advocates of CCT maintain that citizens with the highest degrees of scientific literacy and numeracy are not the most concerned about climate change. Rather, this is the group in which cultural polarization is greatest, and thus individuals with more limited scientific literacy and numeracy are more concerned about climate change under certain circumstances than those with higher scientific literacy and numeracy. The CCT predicts that cultural and other values will trump the positive effects of education on some forest owners' attitudes to climate change. Here, using survey data collected in 2010 from 766 private forest owners in Sweden and Germany, we provide the first evidence that perceptions of climate change risk are uncorrelated with, or sometimes positively correlated with, education level and can be explained without reference to cultural or other values. We conclude that the recent claim that advanced scientific literacy and numeracy polarizes perceptions of climate change risk is unsupported by the forest owner data. In neither of the two countries was university education found to reduce the perception of risk from climate change. Indeed in most cases university education increased the perception of risk. Even more importantly, the effect of university education was not dependent on the individuals' value profile.

The overall aim of this paper is to examine the claim that explanation is asymmetrical because causation is asymmetrical. The link between causal and explanatory asymmetry is focussed on. It is argued that many theories of causation account for causal asymmetry in a way that stops a causal model from contributing to our understanding of explanatory asymmetry. What appears to be generally advantageous with causal approaches is normally true only of a few specific causal accounts. These remaining alternatives, however, may well have some less attractive features that would never be brought to mind in the familiar explanatory contexts of balloons, flag poles, and the like—and with a standard concept of causation.

Kimberly Chuang’s detailed and very helpful reply to my article concerns Jon Elster’s struggle to develop a mechanistic account that sheds light on explanation in social science. I argue that a problem exists with Elster’s current conception of mechanistic explanation in social contexts. Chuang defends Elster’s conception against my critique. I still believe I have identified a problem with Elster’s conception. In this reply I want to recapitulate briefly Elster’s idea, as I understand it, and then use some of Chuang’s critical points to advance the position I advocate.

The functional separation of risk assessment and risk management has long been at the heart of risk analysis structures. Equally long it has been criticized for creating technocratic risk management due to valuations being done in the risk assessment to which the stakeholders do not have access. The criticism has mostly been of an ethical nature. Arguably, in separating risk assessment and risk management, one hopes to fulfil two requirements: Social requirement: we want risk management to meet the goals and needs of society. Scientific requirement: we do not want political views to influence the assessment of facts. We ask in this paper whether it is, in principle, possible to separate risk assessment from risk management. The crucial distinction between risk assessment and risk management we take to be between what kinds of values are involved in them and that separation is meant to shield risk assessment from risk management values and vice versa. Risk assessment is judged to be a scientific activity that should only involve scientific values. We go through a paradigmatic example of good science to see what those scientific values are and whether they are the only ones influencing science. We also present an example of a risk assessment in order to compare it to science. We conclude that the values involved in both science and risk assessment are of the same kind and that they both involve extra-scientific values. The paper ends with a short discussion of whether the above requirements can be met even though risk assessment and risk management are interdependent.

Although contentious, the concept of resilience is common in sustainability research. Critique of the concept have often focused on the content of the concept. In this paper we focus on another feature of concepts, namely how they are defined. We distinguish between concepts that are ostensively defined, that aim to point to some phenomena, and stipulatively defined concepts, where the content of the concept is given in the definition itself. We argue that although definitions themselves are similar across many different disciplines where resilience is used?most notably psychology and ecology?they differ in how. This has interesting consequences for how different disciplines can be connected and integrated. Notably, integration on basis of ostensively defined concepts turn on sharing the extension of the concept, but not necessarily the intension, whereas integration on basis of stipulatively defined concepts work in the opposite way.

Proven experience can be shared. Given this, we cannot assume that the character of proven experience is always manifest as a physical token in each individual sharing it. But the token might still exist somewhere. Perhaps that is a condition of the proven experience’s existence. Something similar could have been accepted as true of scientific knowledge, especially if those who argued that scientific claims were only shorthand for more complicated claims about observations had been right. But it seems that they were not. Hence there might be an ontological difference explaining why there will always be a netto divergence between science and proven experience.

In Swedish law, the notion of ‘science and proven experience’ defines the gold standard for public decision-making and practice, especially in medicine. The notion is notoriously vague but nevertheless plays an important role in the distribution of rights and duties of patients and healthcare workers. For example, failure to provide care in accordance with this standard can lead to penal responsibility. The notion also helps to define Swedish patients’ right to reimbursement for cross-border healthcare. From a legal point of view, the notion is especially intriguing because it appears to import medical standards into the legal conceptual apparatus. The purpose of this article is to explore the mechanisms of this andkindred ‘importing notions’ by investigating the role that the notion of science and proven experience plays in Swedish law and in the transfer of information between the legal and medical fields.

A key question for evidence-based medicine is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with‘science and proven experience’. In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM.

in Undetermined Table d’Hôte Ingar Brinck: Investigating the development of creativity: The Sahlin hypothesis 7 Linus Broström: Known unknowns and proto-second-personal address in photographic art 25 Johan Brännmark: Critical moral thinking without moral theory 33 Martin Edman: Vad är ett missförhållande? 43 Pascal Engel: Rambling on the value of truth 51 Peter Gärdenfors: Ambiguity in decision making and the fear of being fooled 75 Göran Hermerén: NIPT: Ethical aspects 89 Mats Johansson: Roboethics: What problems should be addressed and why? 103 Johan Laserna: Ambivalenta bilder 113 Anna-Sofia Maurin: Metaphysical explanation 161 Kevin Mulligan: Is preference primitive? 169 John D. Norton: How does your garden grow? 181 Johannes Persson & Annika Wallin: The distinction between internal and external validity 187 Johanna Seibt: Becoming our selves 197 Paul Slovic, Robin Gregory, David Frank, and Daniel Vastfjall: Confronting the collapse of humanitarian values in foreignpolicy decision making 209 Peter Sylwan: Det eviga livet 215 Claudine Tiercelin: Chance, love and logic: Ramsey and Peirce on norms, rationality and the conduct of life 221 Epilog 257 Frank Ramsey.

A key question for evidence-based medicine is how best to model the way in which EBM should “[integrate] individual clinical expertise and the best external evidence”. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems. For example, both the early and updated models of evidence-based clinical decisions presented in Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making and practice to be in accordance with ‘science and proven experience’. In the paper we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. In addition the paper sketches the as yet unexplored historical background to EBM.

Researchers often aim to make correct inferences both about that which is actually studied and about what the results generalize to. The language of internal and external validity is not used by everyone, but many of us would agree that intuitively the distinction makes a lot of sense. Two claims are commonly made with respect to internal and external validity. The first is that internal validity is prior to external validity since there is nothing to generalize if the findings obtained in, for instance, the experimental setting do not hold. The first claim is explicit in many writings. See for instance Francisco Guala’s influential book The methodology of experimental economics. And it is often implicitly relied on. The second claim is that researchers have to make a trade-off between internal and external validity. When one is increased, the other will decrease. The second claim was made already from the start by D.T Campbell in his classic Factors relevant to the validity of experiments in social settings. There is a certain tension between the first and the second claim. It has been argued before that it might be difficult to combine them. We intend to make the stronger point that both claims are misconstrued. Our hypothesis is that the relationship between internal and external validity has to be re-conceptualized, and we will briefly indicate how

This paper is an attempt to further our understanding of mechanisms conceived of as ontologically separable from laws. What opportunities are there for a mechanistic perspective to be independent of, or even more fundamental than, a law perspective? Advocates of the mechanistic view often play with the possibility of internal and external reliability, or with the paralleling possibilities of enforcing, counteracting, redirecting, etc., the mechanisms’ power to produce To further this discussion I adopt a trope ontology. It is independent of the notion of law, and can easily be adapted to account for such characteristics of mechanisms. The idea of tropes as mechanisms is worked out in some detail. According to the resulting picture, there is still an opportunity to link mechanisms and laws. But while the predominant law view conceives of mechanistic approaches as special kinds of law accounts, this study indicates that the converse may be true. Law accounts are special cases of mechanistic accounts, and they work only in those worlds where the mechanisms are of the right kind.

Jon Elster worries about the explanatory power of the social sciences. His main concern is that they have so few well-established laws. Elster develops an interesting substitute: a special kind of mechanism designed to fill the explanatory gap between laws and mere description. However, his mechanisms suffer from a characteristic problem that I will explore in this article. As our causal knowledge of a specific problem grows we might come to know too much to make use of an Elsterian mechanism but still lack a law. We might then find ourselves in the paradoxical position of knowing more relevant causal truths about the phenomenon we are interested in than we did before, but being able to explain less. If this possibility is realized in social science settings, as I argue it might well be, Elster?s mechanistic account is threatened. Moreover, even if the possibility is rarely realized in that way, it raises, simply as a possibility, a conceptual problem with Elster?s mechanistic framework

Semmelweis’s work predates the discovery of the power of randomization in medicine by almost a century. Although Semmelweis would not have consciously used a randomized controlled trial (RCT), some features of his material—the allocation of patients to the first and second clinics—did involve what was in fact a randomization, though this was not realised at the time. This article begins by explaining why Semmelweis’s methodology, nevertheless, did not amount to the use of a RCT. It then shows why it is descriptively and normatively interesting to compare what he did with the modern approach using RCTs. The argumentation centres on causal inferences and the contrast between Semmelweis’s causal concept and that deployed by many advocates of RCTs. It is argued that Semmelweis’s approach has implications for matters of explanation and medical practice.

Sometimes instances of perceived causation turn out to lack causal relata. The reasons may vary. Causation may display itself as prevention, or as omission, and in some cases causation occurs within such complex environments that few of the things we associate with causes and effects are true of them, etc. But even then, there may be causal explanations to be had. This suggests that the explanatory power of causal reports have other sources than the relation between cause and effect. In this paper it is argued that the causal mechanisms we allude to in explanations have relevant determinables other than the traditionally acknowledged ones. The traditional but in this aspect mistaken view of causation is to be blamed. Discernability, complexity of manifestation, originality, and even stability have often been overlooked. We know, that, in fact, heat is a constant attendant of flame; but what is the connexion between them, we have no room so much as to conjecture or imagine. (Hume 1777, VII. 2, 64).

Isaac Levi is more interested in inquiry and how it progresses than he is in metaphysics. Questions concerning the role of disposition predicates in inquiry are more central to him than those concerning the nature and reality of dispositions. It has not stopped him from giving me and others very useful metaphysical advice. Currently, where empirical metaphysics is in vogue, there is every reason to see whether the two forms of philosophical interest might interlock substantially. Levi has stimulating ideas indeed on the two forms of philosophical interest, and has recently summarized them in the slogan: “The reality of dispositions is a work in progress”. We can learn much about what kinds of dispositions are acceptable from tracing and comparing the histories of successful and less successful disposition predicates in scientific inquiry. Levi explores one route along which dispositions become real. His idea is that the introduction of dispositions facilitates covering law explanation by increasing the number of laws. The successful disposition predicate eventually becomes integrated in scientific theory, much like an ordinary theoretical term, whereas the unsuccessful does not. My impression is that Levi thinks that this is the only way a disposition can become real. To evaluate this claim, an alternative course suggested by Jon Elster is introduced. I then try to bring out the differences between Levi's and Elster's views on dispositions, partly by suggesting that they resemble two aspects of full explanations discussed by Wesley Salmon. But more about that below

The possibility of apparently negative causation has been discussed in a number of recent works on causation, but the discussion has suffered from beingscattered. In this paper, the problem of apparently negative causation and its attemptedsolutions are examined in more detail. I discuss and discard three attempts that have beensuggested in the literature. My conclusion is negative: Negative causation shows that thetraditional cause & effect view is inadequate. A more unified causal perspective is needed.

According to Jon Elster, mechanisms are frequently occurring and easily recognizable causal patterns that are triggered under generally unknown conditions or with indeterminate consequences. In the absence of laws, moreover, mechanisms provide explanations. In this paper I argue that Elster’s view has difficulties with progressing knowledge. Normally, filling in the causal picture without revising it should not threaten one’s explanation. But this seems to be Elster’s case. The critique is constructive in the sense that it is built up from a discussion of a mechanism that might explain ‘unwarranted’ risk taking in connection with swimming—a mechanism that is mirrored in the proverb: The best swimmers drown

Background Positivism is sometimes rejected for the wrong reasons. Influential textbooks on nursing research and in other disciplines tend to reinforce the misconceptions underlying these rejections. This is problematic, since it provides students of these disciplines with a poor basis for making epistemological and methodological decisions. It is particularly common for positivist views on reality and causation to be obscured. Objectives and design The first part of this discussion paper identifies and explains the misconceptions about positivism as they appear in two influential textbooks. The second part pinpoints five mistakes these misconceptions easily result in when the researcher adopts an epistemological and methodological standpoint. What is already known about the topic? There are several impeccable descriptions of positivism in nursing research literature; but a relatively large number of inaccurate or confused views of positivism appear in the nursing research literature as well. Mistakes of the kind identified in this paper have been noted before—for instance, in Shadish. What this paper adds: This paper provides a detailed analysis of two particularly common and influential misconceptions about positivism. It traces the historical roots of these misconceptions and characterizes them more carefully than many earlier attempts have done. The paper shows how and why these misconceptions affect epistemological and methodological decisions negatively, regardless of one’s interest in positivism