Sarah Jackson

Twentieth century innovations in reasoning about health and medicine (randomized clinical trials, systematic reviews, and a growing list of other inventions) have dramatically changed what counts as good argumentation within this domain. Though these new forms are often highly specialized and highly technical, they are gradually becoming “norms of public argumentation” (Zenker, et al., 2024), spreading from esoteric discussion among medical scientists into other discourses (including interpersonal exchanges between doctors and patients). This pattern is not limited to health and medicine but affects so many domains that it has become ubiquitous in contemporary argumentative discourse. But innovations aimed at improving reasonableness, when successful, can disrupt preexisting normative frameworks. They can undermine and supplant prior bases for inference, abruptly change standards for argument criticism, and require adoption of different rules for argumentative engagement. The study reported here concerns the volatility that surrounds these innovations in a case study of debate over a controversial treatment for a controversial disease. Close examination of the debate from a normative pragmatic perspective shows much greater normative complexity than has been acknowledged within contemporary argumentation theory, including unexpected volatility in norms that arguers themselves must somehow manage.

Argumentation occurring in public controversies (large, long-lasting, and complex disagreements) deserve more attention from argumentation theorists than they have yet received, primarily because they offer plentiful opportunity to discover new facts about the contemporary practice of argumentation. Drawing on the polylogue framework (Lewiński and Aakhus 2023) and the cartography of controversy (Venturini and Munk 2022), nine suggestions are offered for how to build new theoretical knowledge through observational research that combines classic techniques in qualitative social science with emerging computational techniques: (1) aim for observationally grounded theory; (2) anchor analysis in argumentative texts; (3) practice constant comparison; (4) build outward from individual texts to networks; (5) investigate the places where texts are produced; (6) pay attention to the literatures where texts accumulate; (7) leverage computational techniques for natural language processing of large bodies of text; (8) reserve judgment on matters of disagreement within the controversy; and (9) try team science. Recent argument-centered studies of controversies demonstrate aspects of this approach and show its promise for discovering interesting and novel phenomena.

Background Providing understandable information to patients is necessary to achieve the aims of the Informed Consent process: respecting and promoting patients’ autonomy and protecting patients from harm. In recent decades, new, primarily digital technologies have been used to apply and test innovative formats of Informed Consent. We conducted a systematic review to explore the impact of using digital tools for Informed Consent in both clinical research and in clinical practice. Understanding, satisfaction and participation were compared for digital tools versus the non-digital Informed Consent process. Methods We searched for studies on available electronic databases, including Pubmed, EMBASE, and Cochrane. Studies were identified using specific Mesh-terms/keywords. We included studies, published from January 2012 to October 2020, that focused on the use of digital Informed Consent tools for clinical research, or clinical procedures. Digital interventions were defined as interventions that used multimedia or audio–video to provide information to patients. We classified the interventions into 3 different categories: video only, non-interactive multimedia, and interactive multimedia. Results Our search yielded 19,579 publications. After title and abstract screening 100 studies were retained for full-text analysis, of which 73 publications were included. Studies examined interactive multimedia, non-interactive multimedia, and videos, and most studies were conducted on adults. Innovations in consent were tested for clinical/surgical procedures and clinical research. For research IC, 21 outcomes were explored, with a positive effect on at least one of the studied outcomes being observed in 8/12 studies. For clinical/surgical procedures 49 outcomes were explored, and 21/26 studies reported a positive effect on at least one of the studied outcomes. Conclusions Digital technologies for informed consent were not found to negatively affect any of the outcomes, and overall, multimedia tools seem desirable. Multimedia tools indicated a higher impact than videos only. Presence of a researcher may potentially enhance efficacy of different outcomes in research IC processes. Studies were heterogeneous in design, making evaluation of impact challenging. Robust study design including standardization is needed to conclusively assess impact.

Argument is a pervasive feature of human interaction, and in its natural contexts of occurrence, it is organized around the management of disagreement. Since disagreement can occur around any kind of speech act whatsoever, not all arguments involve a claim supported by reasons; many involve standpoints attributed to someone but claimed by no one. And although truth and validity are often at issue in naturally occurring arguments, these do not exhaust the standards to which arguers are held. Arguers hold one another accountable for cooperating in the management of disagreement, infusing argumentation with a natural normativity that exists apart from any theorized appraisal standard applied to the claim-reason relationship. Argumentation’s natural normativity is visible not only in how arguments unfold in interaction but also in how humanity continuously strives to improve its methods of disagreement management.

Contemporary reasoning about health is infused with the work products of experts, and expert reasoning about health itself is an active site for invention and design. Building on Toulmin’s largely undeveloped ideas on field-dependence, we argue that expert fields can develop new inference rules that, together with the backing they require, become accepted ways of drawing and defending conclusions. The new inference rules themselves function as warrants, and we introduce the term “warranting device” to refer to an assembly of the rule plus whatever material, procedural, and institutional resources are required to assure its dependability. We present a case study on the Cochrane Review, a new method for synthesizing evidence across large numbers of scientific studies. After reviewing the evolution and current structure of the device, we discuss the distinctive kinds of critical questions that may be raised around Cochrane Reviews, both within the expert field and beyond. Although Toulmin’s theory of field-dependence is often criticized for its relativism, we find that, as a matter of practical fact, field-specific warrants do not enjoy immunity from external critique. On the contrary, they can be opened to evaluation and critique from any interested perspective.

A background assumption of this paper is that the repertoire of inference schemes available to humanity is not fixed, but subject to change as new schemes are invented or refined and as old ones are obsolesced or abandoned. This is particularly visible in areas like health and environmental sciences, where enormous societal investment has been made in finding ways to reach more dependable conclusions. Computational modeling of argumentation, at least for the discourse in expert fields, will require the possibility of modeling change in a stock of schemes that may be applied to generate conclusions from data. We examine Randomized Clinical Trial, an inference scheme established within medical science in the mid-20th Century, and show that its successful defense by means of practical reasoning allowed for its black-boxing as an inference scheme that generates (and warrants belief in) conclusions about the effects of medical treatments. Modeling the use of a scheme is well-understood; here we focus on modeling how the scheme comes to be established so that it is available for use.