•  4722
    On Evidence and Evidence-Based Medicine: Lessons from the Philosophy of Science
    Social Science and Medicine 62 (11): 2621-2632. 2006.
    The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920–1950). At the same time, the term ‘‘evidence-based medicine’’ has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousnes…Read more
  •  2338
    Public Misunderstanding of Science? Reframing the Problem of Vaccine Hesitancy
    Perspectives on Science 24 (5): 552-581. 2016.
    The public rejection of scientific claims is widely recognized by scientific and governmental institutions to be threatening to modern democratic societies. Intense conflict between science and the public over diverse health and environmental issues have invited speculation by concerned officials regarding both the source of and the solution to the problem of public resistance towards scientific and policy positions on such hot-button issues as global warming, genetically modified crops, environ…Read more
  •  1833
    In accordance with the critical women’s health literature recounting the ways that women are encouraged to submit themselves to various sorts of health “imperatives”, I investigate the messages tacitly conveyed to women in “campaigns for the cure” and breast cancer awareness efforts, which, I argue, overemphasizes a “positive attitude”, healthy lifestyle, and cure rather than prevention of this life-threatening disease. I challenge that the message of hope pervading breast cancer discourse silen…Read more
  •  1619
    The precondition of any feminist politics – a usable category of ‘woman’ – has proved to be difficult to construct, even proposed to be impossible, given the ‘problem of exclusion’. This is the inevitable exclusion of at least some women, as their lives or experiences do not fit into the necessary and sufficient condition(s) that denotes group membership. In this paper, I propose that the problem of exclusion arises not because of inappropriate category membership criteria, but because of the pres…Read more
  •  1411
    Iconoclast or Creed? Objectivism, pragmatism, and the hierarchy of evidence
    Perspectives in Biology and Medicine 52 (2): 168-187. 2009.
    Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical at…Read more
  •  871
    While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despai…Read more
  •  701
    Defining quality of care persuasively
    Theoretical Medicine and Bioethics 33 (4): 243-261. 2012.
    As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine…Read more
  •  350
    Perspectives on Evidence-Based Healthcare for Women
    Journal of Women's Health 19 (7): 1235-1238. 2010.
    We live in an age of evidence-based healthcare, where the concept of evidence has been avidly and often uncritically embraced as a symbol of legitimacy, truth, and justice. By letting the evidence dictate healthcare decision making from the bedside to the policy level, the normative claims that inform decision making appear to be negotiated fairly—without subjectivity, prejudice, or bias. Thus, the term ‘‘evidence-based’’ is typically read in the health sciences as the empirically adequate stand…Read more
  •  280
    Whose social values? Evaluating Canada’s ‘death of evidence’ controversy
    Canadian Journal of Philosophy 45 (3): 404-424. 2015.
    With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed con…Read more
  •  224
    Clinical evidence and the absent body in medical phenomenology: On the need for a new phenomenology of medicine
    International Journal of Feminist Approaches to Bioethics 3 (1): 43-71. 2010.
    The once animated efforts in medical phenomenology to integrate the art and science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literat…Read more
  •  193
    Diversity in Epistemic Communities: A Response to Clough
    Social Epistemology Review and Reply Collective Vol. 3, No. 5. 2014.
    In Clough’s reply paper to me (http://wp.me/p1Bfg0-1aN), she laments how feminist calls for diversity within scientific communities are inadvertently sidelined by our shared feminist empiricist prescriptions. She offers a novel justification for diversity within epistemic communities and challenges me to accept this addendum to my prior prescriptions for biomedical research communities (Goldenberg 2013) on the grounds that they are consistent with the epistemic commitments that I already endorse…Read more
  •  112
    Because few would object to evidence-based medicine’s (EBM) principal task of basing medical decisionmaking on the most judicious and up-to-date evidence, the debate over this prolific movement may seem puzzling. Who, one may ask, could be against evidence (Carr-Hill, 2006)? Yet this question belies the sophistication of the evidence-based movement. This chapter presents the evidence-based approach as a socio-medical phenomenon and seeks to explain and negotiate the points of disagreement betwee…Read more
  •  98
    Virtue, Progress and Practice
    with Michael Loughlin, Robyn Bluhm, Stephen Buetow, Ross E. G. Upshur, Kirstin Borgerson, and Vikki Entwistle
    Journal of Evaluation in Clinical Practice 17 (5): 839-846. 2011.
  •  77
    Countering medical nihilism by reconnecting facts and values
    with Ross Upshur
    Studies in History and Philosophy of Science Part A 84 75-83. 2020.
  •  66
    Clinical evidence and the absent body in medical phenomenology On the need for a new phenomenology of medicine
    International Journal of Feminist Approaches to Bioethics 3 (1): 43-71. 2010.
    Medical discourse currently manages two broad visionary movements: "evidence-based medicine," the effort to make clinical medicine more responsive to the medical research, and "patient-centered care," the platform for a more humane health-care encounter. There have been strong calls to synthesize the two as "evidence-based patient-centred care" (Lacy and Backer 2008; see also Borgmeyer 2005; Baumann, Lewis, and Gutterman 2007; Krahn and Naglie 2008), yet many question the compatibility of the tw…Read more
  •  63
    Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be reject…Read more
  •  55
    Clinical Evidence and the Absent Body in Medical Phenomenology
    International Journal of Feminist Approaches to Bioethiics 3 (1): 43-71. 2010.
    The once animated efforts in medical phenomenology to integrate the art and

    science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literatu…

    Read more
  •  41
    This paper examines the conclusions that one must draw from the finding that there are values in science. The value-ladenness of scientific claims puts the nature and role of empirical evidence into question, as seen in recent discussions in the philosophy of medicine regarding evidence-based medicine and feminist science studies, which maintains the normativity of its feminist claims. Within the critical literature and debates surrounding evidence-based medicine (EBM), one finds a championing o…Read more
  •  37
    Placebo orthodoxy and the double standard of care in multinational clinical research
    Theoretical Medicine and Bioethics 36 (1): 7-23. 2015.
    It has been almost 20 years since the field of bioethics was galvanized by a controversial series of multinational AZT trials employing placebo controls on pregnant HIV-positive women in the developing world even though a standard of care existed in the sponsor countries. The trove of ethical investigations that followed was thoughtful and challenging, yet an important and problematic methodological assumption was left unexplored. In this article, I revisit the famous “double standard of care” c…Read more
  •  34
    Evidence-based ethics? On evidence-based practice and the
    BMC Medical Ethics 6 (1): 11. 2005.
    BackgroundThe increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics.DiscussionThe recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected …Read more
  •  29
    A Response to Sestini's (2011) Response
    Journal of Evaluation in Clinical Practice 17 (5): 1004-1005. 2011.
  •  21
    MA Thesis. Biomedical ethics does not lend itself to easy categorisation as either a 'theoretical' or a 'practical' enterprise because inquiry into the quandaries of morality requires both situational and 'translocal' perspectives. These types of investigation bring into question the legitimacy of the theory/practice divide that has dominated intellectual thought since antiquity. This division hinders the development of bioethics by fostering internal dispute within the discipline regarding appr…Read more
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