Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these (...) states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration. (shrink)

For evidence-based practice and policy, randomised controlled trials (RCTs) are the current gold standard. But exactly why? We know that RCTs do not, without a series of strong assumptions, warrant predictions about what happens in practice. But just what are these assumptions? I maintain that, from a philosophical stance, answers to both questions are obscured because we don't attend to what causal claims say. Causal claims entering evidence-based medicine at different points say different things and, I would suggest, failure to (...) attend to these differences makes much current guidance about evidence for medical and social policy misleading. (shrink)

Approximately 20% of adult cancer patients are eligible to participate in a clinical trial, but only 2.5-9% do so. Accrual is even less for minority and medically underserved populations. As a result, critical life-saving treatments and quality of life services developed from research studies may not address their needs. This study questions the utility of the bioethical concern with therapeutic misconception (TM), a misconception that occurs when research subjects fail to distinguish between clinical research and ordinary treatment, and therefore attribute (...) therapeutic intent to research procedures in the safety net setting. This paper provides ethnographic insight into the ways in which research is discussed and related to standard treatment. (shrink)

Philosophers of science have had little to say about ‘middle-range theory’ although much of what is done in science and of what drives its successes falls under that label. These lectures aim to spark an interest in the topic and to lay groundwork for further research on it. ‘Middle’ in ‘middle range’ is with respect to the level both of abstraction and generality. Much middle-range theory is about things that come under the label ‘mechanism’. The lectures explore three different kinds (...) of mechanism: struc tural mechanisms or underlying systems that afford causal pathways; causal-chain mechanisms that are represented in what in policy contexts are called ‘theories of change’ and for which I give an extended account following the causal process theory of Wesley Salmon; and middle-range-law mechanisms like those discussed by Jon Elster, which I claim are —and rightly are— rampant throughout the social sciences. The theory of the democratic peace, that democracies do not go to war with democracies, serves as a running example. The discussions build up to the start of, first, an argument that reliability in social (and natural) science depends not so much on evidence as it does on the support of a virtuous tangle of practices (without which there couldn’t even be evidence), and second, a defence of a community-practice centred instrumentalist understanding of many of the central basic principles that we use (often successfully) in social (and in natural) science for explanation, prediction and evaluation. (shrink)

A good many models used in physics and economics offer descriptions of imaginary situations, using a combination of mathematics and natural language. The descriptions are both thin - not much about the situation is filled in - and unrealistic - what is filled in is not true of many real situations. Yet we want to use the results of these models to inform our conclusions about a range of actually occurring situations. I propose we interpret many of these models as (...) fables. The actual happenings in the model are only one concrete instantiation of a lesson that is more widely applicable ‘when expressed in more abstract language.' A fable generally comes with the abstract lesson attached; parables, by contrast, usually require an interpretation from outside. Models, then, tend to be more like parables than fables. The right abstract interpretation is not supplied by the model itself. The central problem, then, is where shall it come from? (shrink)

This article examines the cross-generational continuity of community work performed by women living and working in low-income communities and demonstrates the complex ways in which gender, race-ethnicity, and class contribute to the social construction of mothering. The analysis of low-income women's community work challenges definitions of mothering that are limited to biological and legal expressions, thus neglecting the significance of community-based nurturing work for geographic communities and racial-ethnic and class-based groups. The analysis utilizes a broadened understanding of labor and contests (...) the divisions between paid and unpaid work traditionally used to discuss women's work. The article compares and contrasts the experiences of African-American and Latina community workers from low-income communities in New York City and Philadelphia. The findings of the research further demonstrate the ways that knowledge generated from the standpoint of women from different classes and racial-ethnic backgrounds transforms our understanding of politics, labor, and mothering. (shrink)

The paper frames interdisciplinary research as creating complex, distributed cognitive-cultural systems. It introduces and elaborates on the method of cognitive ethnography as a primary means for investigating interdisciplinary cognitive and learning practices in situ. The analysis draws from findings of nearly 20 years of investigating such practices in research laboratories in pioneering bioengineering sciences. It examines goals and challenges of two quite different kinds of integrative problem-solving practices: biomedical engineering (hybridization) and integrative systems biology (collaborative interdependence). Practical lessons for facilitating (...) research and learning in these specific fields are discussed and a preliminary set of interdisciplinary epistemic virtues are proposed as candidates for cultivation in interdisciplinary practices of these kinds more widely. (shrink)

This paper defends the need for evidential diversity and the mix of methods that that can in train require. The focus is on causal claims, especially ‘singular’ claims about the effects of causes in a specific setting—either what will happen or what has happened. I do so by offering a template that categorises kinds of evidence that can support these claims. The catalogue is generated by considering what needs to happen for a causal process to carry through from putative cause (...) at the start to the targeted effect at the end. The usual call for mixed methods focusses on a single overall claim and argues that we increase certainty by the use of different methods with compensating strengths and weaknesses. My proposals instead focus on the evidence that supports the great many subsidiary claims that must hold if the overall one is to be true. As is typical for singular causal claims, the mix of methods that will generally be required to collect the kinds of evidence I urge will usually have little claim to the kind of rigour that is now widely demanded in evidencing causal claims, especially those for policy/treatment effectiveness. So I begin with an exploration of what seems to be intended by ‘rigour’ in such discussions, since it is seldom made clear just what makes the favoured methods especially rigorous. I then argue that the emphasis on rigour can be counterproductive. Rigour is often the enemy of evidential diversity, and evidential diversity—lots of it—can make for big improvements in the reliability of singular causal predictions and post hoc evaluations. I illustrate with the paragon of rigour for causal claims, randomised controlled trials (RCTs), rehearsing at some length what they can and cannot do to make it easier to assess the importance of rigour in warranting singular causal claims. (shrink)

This volume features new findings by nine interdisciplinary teams of researchers on the topics of self, motivation, and virtue. Nine chapters bringing together scholars from the fields of philosophy, psychology, neuroscience, and sociology advance our substantive understanding of these important topics, and showcase a variety of research methods of interdisciplinary interest. Essays on Buddhism and the self in the context of romantic relationships, the development of personal projects and virtue, the notion of self-distancing and its moral impact, virtues as self-integrated (...) traits, humility and the self in loving encounter, the importance of nation and faith in motivating virtue in western and non-western countries, roles for the self and virtue in eudaimonic growth, overcoming spiritual violence and sacramental shame in Christian communities, and an investigation into the moral self highlight the range and diversity of topics explored in this volume. The concept of deep integration also characterizes this work: each member of the interdisciplinary teams was fully and equally invested in their project from inception to completion. This approach invites teams to examine their disciplinary assumptions, rethink familiar concepts, and adjust methodologies in order to view their topics with fresh eyes. The result is not only new findings of substantive and methodological interest, but also an interesting glimpse into the thinking of the researchers as they sought interdisciplinary common ground in their research. Self, Motivation, and Virtue will be of interest to scholars in philosophy, moral psychology, neuroscience, and sociology who are working on these topics. (shrink)

This collection of original essays examines innovations in both the theory and practice of classical philology. The chapters address interdisciplinary methods in a variety of ways. Some apply theoretical insights derived from other disciplines, such as folklore studies, performance theory, feminist criticism, and the like, to classical texts. Others examine the relationships between classics and cultural studies, popular literature, film, art history, and other related disciplines. Others, again, look to the evolution of theoretical methods within the discipline of classics. Taken (...) together, the essays offer a spectrum of new approaches in the classics and their place within the profession. (shrink)

The precautionary principle is an emerging principle of international law but has only recently been proposed in North America as a new basis for environmental policy. On the surface it is a simple, common-sense proposition: in the face of possible harm, exercise precaution. But the enthusiasm the principle has stirred among public advocates suggests it has a deeper appeal. It is, in fact, based on values related to “forecaring for life” and the natural world. The principle cannot effectively be invoked (...) without stating these values up front. The principle makes it clear that decisions and developments in science and technology are based first of all on values and only secondarily on scientific and technological fact and process. Moreover, a precautionary approach is best carried out in the context of goals that embody the values of communities and societies. (shrink)

This article addresses the gap between what works in research and what works in practice. Currently, research in evidence-based education policy and practice focuses on randomized controlled trials. These can support causal ascriptions (“It worked”) but provide little basis for local effectiveness predictions (“It will work here”), which are what matter for practice. We argue that moving from ascription to prediction by way of causal generalization (“It works”) is unrealistic and urge focusing research efforts directly on how to build local (...) effectiveness predictions. We outline various kinds of information that can improve predictions and encourage using methods better equipped for acquiring that information. We compare our proposal with others advocating a better mix of methods, like implementation science, improvement science, and practice-based evidence. (shrink)

Our response to death may differ depending on the patient’s age. We may feel that death is a sad, but acceptable event in an elderly patient, yet feel that death in a very young patient is somehow unfair. This paper explores whether there is any ethical basis for our different responses. It examines in particular whether a patient’s age should be relevant to the determination that an intervention is medically futile. It also considers the responsibilities of health professionals and the (...) rights of family members in situations where an interventions is clearly futile. (shrink)

In this review of papers by E. O. Wilson, Philip Gorski, and Robert Segal, I apply Wilson's description of the relations between a discipline and its antidiscipline (the science just below it in the hierarchy of sciences) to the relations between theology and the social sciences. I claim (contra Gorski) that a common methodology is applicable to natural science, social science, and theology. However, despite the fact that a discipline cannot ordinarily be reduced to its antidiscipline, I claim (with Segal) (...) that it remains to be shown that a theistic interpretation of religious phenomena is superior to a social‐scientific explanation. I see this as work to be done rather than an impossibility. Insofar as it is shown that theology cannot be reduced to social‐scientific explanations, support is provided for the hypothesis of the existence of God. (shrink)

In September 1994, theNew York Timescarried a front page article declaring healthcare reform dead in Congress. The obituary on healthcare followed a Congressional decision not to pursue the issue further in 1994. Although Congress and the President will likely revisit healthcare reform during 1995, the choices may be between various incremental steps, rather than substantive changes to bring about universal coverage.

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article on (...) the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy... (shrink)

Drug testing is widely deployed in the United States throughout the public and private sectors. This case study uses two emergent drug-testing technologies—hair analysis and the sweat patch—as examples of techniques of governance that should be subjected to the political equivalent of strict scrutiny. The article contributes to conceptual debates in science and technology studies, arguing that the study of social structure and subject formation should be integral rather than epiphenomenal to analysis in the transdisciplinary field of science and technology (...) studies. The article contextualizes the development and deployment of drug-testing technologies within the structural and epistemological categories of racial and ethnic difference, gender, sexuality, and class formation. Conflicts between proponents of the technologies and critical advocates who seek to constrain their use mark sites of productive theoretical engagement with structural sociology, racial formation theory, critical race theory, and feminist critique.1 Finally, the article demonstrates how STS analyses can contribute to the struggles of strategic counterpublics as they advocate for changing the meaning and material consequences of suspect technologies. (shrink)