Sir Austin Bradford Hill’s ‘aspects of causation’ represent some of the most influential thoughts on the subject of proximate causation in health and disease. Hill compiled a list of features that, when present and known, indicate an increasing likelihood that exposure to a factor causes—or contributes to the causation of—a disease. The items of Hill’s list were not labelled ‘criteria’, as this would have inferred every item being necessary for causation. Hence, criteria that are necessary (...) for causation in health, disease and intervention processes, whether known, knowable, or not, remain undetermined and deserve exploration. To move beyond this position, this paper aims to explore factors that are necessary in the constitution of causative relationships between health, disease processes, and intervention. To this end, disease is viewed as a causative pathway through the often overlapping stages of aetiology, pathology and patho-physiology. Intervention is viewed as a second, independent causative pathway, capable of causing changes in health for benefit or harm. For the natural course of a disease pathway to change, we argue that intervention must not only occupy the same time and space, but must also share a common form; the point at which the two pathways converge and interact. This improved conceptualisation may be used to facilitate the interpretation of clinical observations and inform future research, particularly enabling predictions of the mechanistic relationship between health, disease and intervention. (shrink)

Epidemiology relies upon a broad interpretation of determinism. This paper discusses analogies with the evolution of the concept of cause in physics, and analyzes the classical nine criteria proposed by Sir Austin Bradford Hill for causal assessment. Such criteria fall into the categories of enumerative induction, eliminative induction, deduction and analogy. All of these four categories are necessary for causal assessment and there is no natural hierarchy among them, although a deductive analysis of the study design is (...) preliminary to any assessment. (shrink)

Mistake-making is a common feature of life; it can be given a rigorous theoretical framework. The theory, though, faces a challenge from the ‘functions debate’. Perhaps mistakes are merely malfunctions, so a theory of mistakes requires a stance on functions. However, mistake theory views mistakes as distinct phenomena, not just malfunctions. The functions debate is largely separate from the concept of biological mistakes. While the selected effects theory, for instance, may retain its place within a pluralistic view of function, embracing (...) a robust concept of normativity that goes beyond a relatively narrow conception of function can drive future experimental research. (shrink)

Organisms and other biological entities are mistake-prone: they get things wrong. The entities of pure physics, such as atoms and inorganic molecules, do not make mistakes: they do what they do according to physical law, with no room for error except on the part of the physicist or their theory. We set out a novel framework for understanding biology and its demarcation from physics – that of mistake-making. We distinguish biological mistakes from mere failures. We then propose a rigorous definition (...) of mistakes that, although invoking the concept of function, is compatible with various views about what functions are. The definition of mistake-making is agential, since mistakes do not just happen ¬– at least in the sense analysed here – but are made. This requires, then, a notion of biological agency which we set out as a definition of the Minimal Biological Agent. The paper then considers a series of objections to the theory presented here, along with our replies. Two key features of our theory of mistakes are, first, that it is a supplement to, not a replacement for, existing general frameworks within which biology is understood and practised. Secondly, it is designed to be experimentally productive. Hence we end with a series of case studies where mistake theory can be shown to be useful in the potential generation of research questions and novel hypotheses of interest to the working biologist. (shrink)

Neurodevelopmental disorders such as autism affect one-eighth of all U.S. newborns. Yet scientists, accessing the same data and using Bradford-Hill guidelines, draw different conclusions about the causes of these disorders. They disagree about the pesticide-harm hypothesis, that typical United States prenatal pesticide exposure can cause neurodevelopmental damage. This article aims to discover whether apparent scientific disagreement about this hypothesis might be partly attributable to questionable interpretations of the Bradford-Hill causal guidelines. Key scientists, who claim to employ (...) Bradford-Hill causal guidelines, yet fail to accept the pesticide-harm hypothesis, fall into errors of trimming the guidelines, requiring statistically-significant data, and ignoring semi-experimental evidence. However, the main scientists who accept the hypothesis appear to commit none of these errors. Although settling disagreement over the pesticide-harm hypothesis requires extensive analysis, this article suggests that at least some conflicts may arise because of questionable interpretations of the guidelines. (shrink)

Establishing the effectiveness of medical treatments is one of the most important aspects of medical practice. Bradford Hill's viewpoints play an important role in inferring causality in medicine,...

In the early seventeenth century, the amount of meat available in Rome increased exponentially, with consumption reaching a pound per person per day in the 1630s. There were cultural and political reasons for this surge: in the wake of the Reformation, a series of popes sought to turn the city of Rome into a model “city on a hill,” representing the ideal of a Catholic state under a powerful ruler. However, to bring such large amounts of food from the (...) countryside to Roman tables required enormous efforts on the part of a variety of bureaucrats and local artisans working for the papal regime. This essay will briefly examine the efforts of two of those groups that helped create Rome’s “meat moment”: the contatori who inspected and distributed animals brought from the countryside to Rome and the butchers in the city. In the end, the dramatic increase in supply was not sustainable and would result in both political and ecological upheaval. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Bradford Hill (1965) highlighted nine aspects of the complex evidential situation a medical researcher faces when determining whether a causal relation exists between a disease and various conditions associated with it. These aspects are widely cited in the literature on epidemiological inference as justifying an inference to a causal claim, but the epistemological basis of the Hill aspects is not understood. We offer an explanatory coherentist interpretation, explicated by Thagard's ECHO model of explanatory coherence. The ECHO model (...) captures the complexity of epidemiological inference and provides a tractable model for inferring disease causation. We apply this model to three cases: the inference of a causal connection between the Zika virus and birth defects, the classic inference that smoking causes cancer, and John Snow’s inference about the cause of cholera. (shrink)

For the large public, the only enduring legacy of Dugald Stewart (1753–1828) is the choragic monument on Calton Hill commissioned by the Royal Society of Edinburgh soon after his death, in 1828, an...

The epidemiologist Bradford Hill famously argued that in epidemiology, specificity of association (roughly, the fact that an environmental or behavioral risk factor is associated with just one or at most a few medical outcomes) is strong evidence of causation. Prominent epidemiologists have dismissed Hill’s claim on the ground that it relies on a dubious `one-cause one effect’ model of disease causation. The paper examines this methodological controversy, and argues that specificity considerations do have a useful role to (...) play in causal inference in epidemiology. More precisely, I argue that specificity considerations help solve a pervasive inferential problem in contemporary epidemiology: the problem of determining whether an exposure-outcome correlation might be due to confounding by a social factor. This examination of specificity has interesting consequences for our understanding of the methodology of epidemiology. It highlights how the methodology of epidemiology relies on local tools designed to address specific inference problems peculiar to the discipline, and shows that observational causal inference in epidemiology can proceed with little prior knowledge of the causal structure of the phenomenon investigated. I also argue that specificity of association cannot (despite claims to the contrary) be entirely explained in terms of Woodward’s well-known concept of “one-to-one” causal specificity. This is because specificity as understood by epidemiologists depends on whether an exposure (or outcome) is associated with a `heterogeneous’ set of variables. This dimension of heterogeneity is not captured in Woodward’s notion, but is crucial for understanding the evidential import of specificity of association. (shrink)

Nancy Cartwright begins her recent book, Hunting Causes and Using Them, by noting that while a few years ago real causal claims were in dispute, nowadays “causality is back, and with a vengeance.” In the case of the social sciences, Keith Morrison writes that “Social science asks ‘why?’. Detecting causality or its corollary—prediction—is the jewel in the crown of social science research.” With respect to the health sciences, Judea Pearl writes that the “research questions that motivate most studies in the (...) health sciences are causal in nature.” However, not all data used by people interested in making causal claims come from experiments that use random assignment to control and treatment groups. Indeed, much research in the social and health science depends on non-experimental, observational data. Thus, one of the most important problems in the social and health sciences concerns making warranted causal claims using non-experimental, observational data; viz., “Can observational data be used to make etiological inferences leading to warranted causal claims?” This paper examines one method of warranting causal claims that is especially widespread in epidemiology and the health sciences generally—the use of causal criteria. It is argued that cases of complex causation generally, and redundant causation—both causal overdetermination and causal preemption—specifically, undermine the use of such criteria to warrant causal claims. (shrink)

Background: Evidence suggesting adverse drug reactions often emerges unsystematically and unpredictably in form of anecdotal reports, case series and survey data. Safety trials and observational studies also provide crucial information regarding the (un-)safety of drugs. Hence, integrating multiple types of pharmacovigilance evidence is key to minimising the risks of harm. Methods: In previous work, we began the development of a Bayesian framework for aggregating multiple types of evidence to assess the probability of a putative causal link between drugs and side (...) effects. This framework arose out of a philosophical analysis of the Bradford Hill Guidelines. In this article, we expand the Bayesian framework and add “evidential modulators,” which bear on the assessment of the reliability of incoming study results. The overall framework for evidence synthesis, “E-Synthesis”, is then applied to a case study. Results: Theoretically and computationally, E-Synthesis exploits coherence of partly or fully independent evidence converging towards the hypothesis of interest (or of conflicting evidence with respect to it), in order to update its posterior probability. With respect to other frameworks for evidence synthesis, our Bayesian model has the unique feature of grounding its inferential machinery on a consolidated theory of hypothesis confirmation (Bayesian epistemology), and in allowing any data from heterogeneous sources (cell-data, clinical trials, epidemiological studies), and methods (e.g., frequentist hypothesis testing, Bayesian adaptive trials, etc.) to be quantitatively integrated into the same inferential framework. Conclusions: E-Synthesis is highly flexible concerning the allowed input, while at the same time relying on a consistent computational system, that is philosophically and statistically grounded. Furthermore, by introducing evidential modulators, and thereby breaking up the different dimensions of evidence (strength, relevance, reliability), E-Synthesis allows them to be explicitly tracked in updating causal hypotheses. (shrink)

An astonishing volume and diversity of evidence is available for many hypotheses in the biomedical and social sciences. Some of this evidence—usually from randomized controlled trials (RCTs)—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not RCTs are the ‘gold-standard’ of evidence, it is usually meta-analysis which is considered the best source of evidence: meta-analysis is thought by many to be the platinum standard of evidence. However, I argue that meta-analysis falls far short of that standard. Different meta-analyses (...) of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for intersubjective assessments of hypotheses because numerous decisions must be made when performing a meta-analysis which allow wide latitude for subjective idiosyncrasies to influence its outcome. I end by suggesting that an older tradition of evidence in medicine—the plurality of reasoning strategies appealed to by the epidemiologist Sir Bradford Hill—is a superior strategy for assessing a large volume and diversity of evidence. (shrink)

In many toxic-tort cases - notably in Oxendine v. Merrell Dow Pharmaceuticals, Inc, and in Joiner v. G.E., - plaintiffs argue that the expert testimony they wish to present, though no part of it is sufficient by itself to establish causation "by a preponderance of the evidence," is jointly sufficient to meet this standard of proof; and defendants sometimes argue in response that it is a mistake to imagine that a collection of pieces of weak evidence can be any stronger (...) than its individual components. This article draws on the epistemological theory I first presented in 1993 in Evidence and Inquiry, and then amplified and refined in 2003 in Defending Science - Within Reason. This theory of evidence shows that, under certain conditions, a combination of pieces of evidence none of which is sufficient by itself really can warrant a casual conclusion to a higher degree than any of its components alone. When my account is applied to the very complex congeries of evidence typically proffered to prove general causation in these toxic-tort cases, it improves on the influential "Bradford Hill criteria" for assessing causation; and it suggests answers to questions frequently raised in such cases: e.g., whether epidemiological evidence is essential for proof of causation, and whether such evidence should be excluded if it is not statistically significant. Moreover, the argument of this paper reveals that by obliging courts to screen each item of expert testimony individually for reliability, the atomism implicit in Daubert will sometimes stand in the way of an accurate assessment of the worth of complex causation evidence. (shrink)

Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown (...) that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP. (shrink)

Changes in the methodology of the historical sciences make them more vulnerable to unjustifiable speculations being passed off as scientific results. The integrity of historical science is in peril due the way speculative and often unexamined causal assumptions are being used to generate data and underpin the identification of correlations in such data. A step toward a solution is to distinguish between plausible and speculative assumptions that facilitate the inference from measured and observed data to causal claims. One way to (...) do that is by comparing these assumptions against a well-attested set of aspects of causation, such as the so-called “Bradford Hill Criteria”. The BHC do not provide a test for causation or necessary and sufficient conditions for causation but do indicate grounds for further investigation. By revising the BHC to reflect the needs and focus of historical sciences, it will be possible to assess the cogency of methods of investigation. These will be the Historical Sciences Bradford Hill Criteria. An application to one area in historical science is used to demonstrate the effectiveness of the HSBHC, namely biogeography. Four methods are assessed in order to show how the HSBHC can be used to examine the assumptions between our data and the causal biogeographical processes we infer. (shrink)

J. L. Austin showed that performative speech acts can fail in various ways, and that the ways in which they fail can often be revealing, but he was not concerned with understanding performative failures that occur in the context of poetry. Geoffrey Hill suggests, in both his poetry and his prose writings, that these failures are more interesting than Austin realized. This article corrects Maximilian de Gaynesford’s misunderstanding of Hill’s treatment of this point. It then explains (...) the way in which Hill’s understanding of the performative restrictions on poetry relate to his conception of poetry’s role, analogous to that of the Saturnalian misruler, in establishing the authority of ordinary language. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 3. © 2018 by Feminist Studies, Inc. 699 Jennifer C. Nash The Political Life of Black Motherhood In 1976, Adrienne Rich wrote, “We know more about the air we breathe, the seas we travel, than about the nature and meaning of motherhood.”1 In the four decades since the publication of Rich’s now-canonical Of Woman Born, Andrea O’Reilly has argued for the advent of “maternal theory” (...) as an academic discipline, the maternal memoir has become a highly popular (and profitable) literary genre, and there has been sustained attention to maternal activism with scholarly analyses of such organizations as Mothers Against Drunk Driving and Mothers of the Movement.2 If Mamie Till Bradley boldly “let the world see” her son’s mutilated body in a 1955 public plea to make visible black suffering and antiblack violence, Valerie Castile’s statement after a jury found a police officer not guilty in the death of her son continued in the tradition of 1. Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (New York: W. W. Norton, 1995), 11. 2. See Andrea O’Reilly, ed., Maternal Theory: A Reader (New York: Demeter Press, 2007); Ann Hulbert, “The Real Myth of Motherhood,” Slate, March 8, 2005; Jennifer C. Nash and Samantha Pinto, “Strange Intimacies: Reading Black Mothering Memoirs,” Public Culture (forthcoming); Danielle Poe, Maternal Activism: Mothers Confronting Injustice (Albany: SUNY Press, 2016); and Ruth Feldstein, Motherhood in Black and White: Race and Sex in American Liberalism, 1930–1965 (Ithaca, NY: Cornell University Press, 2000). 700 Jennifer C. Nash Books Discussed in This Essay Revolutionary Mothering: Love on the Front Lines. Edited by Alexis Pauline Gumbs, China Martens, and Mai’a Williams. Oakland, CA: PM Press, 2016. Laboring Positions: Black Women, Mothering and the Academy. Edited by Sekile Nzinga-Johnson. Bradford, ON: Demeter Press, 2013. How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to Trump. By Laura Briggs. Oakland: University of California Press, 2017. Birthing Justice: Black Women, Pregnancy, and Childbirth. Edited by Julia Oparah and Alicia Bonaparte. New York: Routledge, 2016. making black (male) pain visible through grief-stricken black motherhood. Castile said, My son loved this state. He had one tattoo on his body and it was of the twin cities, the state of Minnesota with “TC” on it. My son loved this city, and this city killed my son and the murderer gets away.... We’re not evolving as a civilization, we’re devolving, we have taken steps forward, people have died for us to have these rights and now we’re devolving, we’re going back to 1969.3 Her emotional plea reveals the political currency of black maternal suffering, one of the few spaces in which black pain is readily culturally visible. Indeed, there has been intensified scholarly and popular interest in representing black motherhood as both a site constituted by grief and expected loss and as a political position made visible (only) because of its proximity to death. It is certainly the case that a cultural inattention to motherhood has been replaced by an intense investment in representing at least some aspects of “the nature and meaning of motherhood” and 3. “Philando Castile’s Mother Reacts to Verdict,” Washington Post video on YouTube, posted on June 16, 2017, https://www.youtube.com/watch?v=RJsD4cCpUA. Jennifer C. Nash 701 in representing certain mothers—particularly black mothers—as symbols of trauma and injury, of pain that can be mobilized for “legitimate” political ends and social change. If, as O’Reilly suggests, maternal theory is now a distinct field, it has been fundamentally shaped by the intellectual and political labor of black feminists—Dorothy Roberts, bell hooks, Alice Walker, Patricia Hill Collins, Hortense Spillers, and Audre Lorde—who have captured the myriad ways that black maternity is cast as pathological, excessive, and marked by aberrant performances of gender and heterosexuality that threaten both the nuclear family and the heterosexual state. Drawing on a varied archive from the Moynihan Report to cultural panics about “kids having kids,” from ongoing representations of black women’s “failure” to breastfeed as a public health crisis to the racialized underpinnings of birth control, black feminist theory... (shrink)

It is widely believed that shapes are intrinsic properties. But this claim is hard to defend. I survey all known theories of shape properties, and argue that each theory is either incompatible with the claim that shapes are intrinsic, or can be shown to be false.

We make physical efforts when we swim, carry shopping bags, push heavy doors, or cycle up hills. A growing concern among philosophers and scientists in related fields is the absence of a well-defined concept for physical efforts. This paper addresses this issue by presenting a force-based definition of physical efforts. In Sect. 1, we explore the shortcomings of existing definitions of effort. Section 2 introduces the force-based account of efforts according to which making an effort consists in exerting a force (...) so as to make an object move or stay at rest. Section 3 introduces three central distinctions stemming from the account: failed vs. successful efforts; resisted vs. unresisted efforts; and efforts vs. effortful actions. Section 4 presents a key objection, to the effect that the force-based theory cannot account for the difficulty of efforts: efforts usually feel difficult, but effort’s difficulty is not always a function of the magnitude of force(s) exerted. Section 5 argues that the most in-depth account of difficulty so far, that developed by Bradford ( 2015 ), cannot account for the difficulty of efforts. Sections 6 & 7 develop a novel account of effort’s difficulty. (shrink)

In Algorithms & Autonomy, Rubel, Castro, and Pham (hereafter RCP), argue that the concept of autonomy is especially central to understanding important moral problems about algorithms. In particular, autonomy plays a role in analyzing the version of social contract theory that they endorse. I argue that although RCP are largely correct in their diagnosis of what is wrong with the algorithms they consider, those diagnoses can be appropriated by moral theories RCP see as in competition with their autonomy based theory. (...) Most notably, proponents of consequentialism and virtue ethics can appropriate RCPs insights. This is good news because RCP’s social contract theory is vulnerable to a well known class of counterexamples. The most significant contribution of RCP, if I am right, is in their identification, presentation, and evaluation of concrete cases involving algorithms and not in the more controversial claims about theoretical ethics that RCP themselves see as central to what they are doing. (shrink)

Many philosophers and members of the public think it is wrong to procreate. If one wants children, it is permissible to adopt. But procreation is allegedly impermissible because there is some respect in which adoption is better than procreation. I show that such objections are unsound.

It is better when people get what they deserve. So we need an axiology according to which the intrinsic value of a possible world is a function of both how well-off and how deserving the people in that world are. But how should these ?desert-adjusted? values of possible worlds be calculated? It is easy to come up with some qualitative ideas. But these qualitative ideas leave us with an embarrassment of riches: too many quantitative functions that implement those qualitative ideas. (...) In this paper I will select one of these quantitative functions and defend its superiority. (shrink)

There are lots of arguments for, or justifications of, mathematical theorems that make use of principles from physics. Do any of these constitute explanations? On the one hand, physical principles do not seem like they should be explanatorily relevant; on the other, some particular examples of physical justifications do look explanatory. In this article, I defend the idea that physical justifications can and do explain mathematical facts. 1 Physical Arguments for Mathematical Truths2 Preview3 Mathematical Facts4 Purity5 Doubts about Purity: I6 (...) Doubts about Purity: II7 How Physical Arguments Might Explain: I8 How Physical Arguments Might Explain: II9 Conclusion. (shrink)

Affirmative action programs remain controversial, I suspect, partly because the familiar arguments for and against them start from significantly different moral perspectives. Thus I want to step back for a while from the details of debate about particular programs and give attention to the moral viewpoints presupposed in differenttypesof argument. My aim, more specifically, is to compare the “messages” expressed when affirmative action is defended from different moral perspectives. Exclusively forward-looking (for example, utilitarian) arguments, I suggest, tend to express the (...) wrong message, but this is also true of exclusively backward-looking (for example, reparation-based) arguments. However, a moral outlook that focuses on cross-temporal narrative values (such as mutually respectful social relations) suggests a more appropriate account of what affirmative action should try to express. Assessment of the message, admittedly, is only one aspect of a complex issue, but it is a relatively neglected one. My discussion takes for granted some common-sense ideas about the communicative function of action, and so I begin with these.Actions, as the saying goes, oftenspeaklouder than words. There are times, too, when only actions can effectively communicate the message we want to convey and times when giving a message is a central part of the purpose of action. What our actions say to others depends largely, though not entirely, upon our avowed reasons for acting; and this is a matter for reflective decision, not something we discover later by looking back at what we did and its effects. The decision is important because “the same act” can have very different consequences, depending upon how we choose to justify it. (shrink)

In an important and widely cited paper, Zerilli, Knott, Maclaurin, and Gavaghan (2019) argue that opaque AI decision makers are at least as transparent as human decision makers and therefore the concern that opaque AI is not sufficiently transparent is mistaken. I argue that the concern about opaque AI should not be understood as the concern that such AI fails to be transparent in a way that humans are transparent. Rather, the concern is that the way in which opaque AI (...) is opaque is very different than the way in which humans are opaque. What matters is the degree to which the opaque processes of a class of decision makers are stable, uniform, and safe. The degree to which such processes have these features in humans is higher than the degree to which such processes have these features in opaque AI. And therefore we should require AI to be more transparent than humans. (shrink)

I defend the theory that the reasons why some event occurred are its causes. Many “counterexamples” to this theory turn on confusing two levels of reasons. We should distinguish the reasons why an event occurred from the reasons why those reasons are reasons. An example that treats a second-level reason as a first-level reason will look like a counterexample if that second-level reason is not a cause. But second-level reasons need not be first-level reasons.

The fitness of a eukaryote hinges on the coordinated function of the products of its nuclear and mitochondrial genomes in achieving oxidative phosphorylation. I propose that sexual selection plays a key role in the maintenance of mitonuclear coadaptation across generations because it enables pre-zygotic sorting for coadapted mitonuclear genotypes. At each new generation, sexual reproduction creates new combinations of nuclear and mitochondrial genes, and the potential arises for mitonuclear incompatibilities and reduced fitness. In reviewing the literature, I hypothesize that individuals (...) engaged in mate choice select partners with correct species-typical mitochondrial and nuclear genotypes as well as individuals with highly functional cellular respiration. The implication is that mate choice for compatible nuclear and mitochondrial genes can play a significant role in generating the patterns of ornamentation and preferences observed in animals. A number of testable predictions emerge from this mitonuclear compatibility hypothesis of sexual selection. Products of mitochondrial and nuclear genes co-function to enable cellular respiration, so it is critical that compatible mitochondrial and nuclear genes be matched each generation. I propose that a core function of mate choice is selection for mitochondrial and nuclear genes that create compatible and functional combinations in offspring. (shrink)