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DRUG FACTS, VALUES, AND THE MORNING-AFTER PILL
Abstract
While the Value-Free Ideal of science has suffered compelling criticism, some advocates like Gregor Betz continue to argue that science policy advisors should avoid value judgments by hedging their hypotheses. This approach depends on a mistaken understanding of the relations between facts and values in regulatory science. My case study involves the morning-after pill Plan B and the “Drug Fact” that it “may” prevent implantation. I analyze the operative values, which I call zygote-centrism, responsible for this hedged drug label. Then, I explain my twofold account of value-ladenness, involving the constitutive role of value judgments in science and the social function of facts as political tools. Because this drug fact is ineliminably value-laden in both senses, I conclude that hedged hypotheses are not necessarily value-free. https://philpapers.org/go.pl?id=CHODFV&u=https%3A%2F%2Fphilpapers.org%2Farchive%2FCHODFV.pdf
The Value-free ideal of science (VFI) is a view that claims that scientists should not use non-epistemic values when they are justifying their hypotheses, and is widely considered to be obsolete in the philosophy of science. I will defend the ideal by demonstrating that acceptance of non-epistemic values, prohibited by VFI, necessitates legitimizing certain problematic scientific practices. Such practices, including biased methodological decisions or Questionable Research Practices (QRP), significantly contribute to the Replication Crisis. I will argue that the realizability of VFI is not a necessary condition for its validity. Then, I will show how some of the prominent proposals of value-laden science legitimize problematic scientific practices, provide real-world examples, and generalize the argument. Finally, I will show how value-laden methodological decisions contribute to the Replicability Crisis and discuss two strategies for realizing VFI.
Este artículo examina un nuevo tipo de tensión, identificada en el seno de la filosofía de las prácticas científicas, entre la pretensión de desarrollar una ciencia imparcial y el hecho aceptado de que en la ciencia se presuponen valores no epistémicos. Para situarla en su contexto y comprender sus pormenores, presentamos primero el ideal que la subyace, el ICV (ciencia sin valores), cuya inconveniencia se reconoce ahora abiertamente en el ámbito de la filosofía de la ciencia acerca de los valores (epistémicos y no epistémicos), ante todo en el caso de la búsqueda de una imparcialidad mejorada. La variedad de estudios sobre valores, sin embargo, ha permitido plantear un nuevo problema de demarcación, situado ahora en contextos de incertidumbre y riesgo, centrado en la legitimidad (o ilegitimidad) de los valores que presuponen las actividades cognitivas. En este contexto surge el nexo entre los valores y la cuestión de un conocimiento pretendidamente imparcial, para el que proponemos un intento de solución.
Among feminist philosophers, there are two lines of argument that sexist values are illegitimate in science, focusing on epistemic or ethical problems. This article supports a third framework, elucidating how value-laden science can enable epistemic oppression. My analysis demonstrates how purported knowledge laden with sexist values can compromise epistemic autonomy and contribute to paternalism and misogyny. I exemplify these epistemic wrongs with a case study of the morning-after pill (emergency contraception) during its 2006 switch to over-the-counter availability and its new drug label from the US Food and Drug Administration that it “may prevent implantation.” Antiabortion science advisers created this label to protect zygotes based on debated value judgments that were later concealed. This zygote-centric knowledge enabled them to shape potential users by instructing “good mothers” that they ought to protect zygotes and punishing “bad mothers” by refusing their requests for the drug. Therefore, I argue that the sexist values and gender norms of antiabortionists that prioritize zygotic health are illegitimate in this context because they cause epistemic injustices and perpetuate epistemic oppression. Furthermore, I advocate against blanket protections for the “right to conscience” and “religious freedom” of healthcare providers because they reinforce the epistemic oppression of women, especially those on the margins.
Content Warning : This article discusses sexual assault and refusals to provide contraception to patients, including survivors.
This commentary defends three arguments for changing the label of levonorgestrel-based emergency contraception (LNG EC) so that it no longer supports the possibility of a mechanism of action after fertilization. First, there is no direct scientific evidence confirming any post-fertilization mechanisms. Second, despite the weight of evidence, there is still widespread public misunderstanding over the mechanism of LNG EC. Third, this FDA label is not a value-free claim, but instead it has functioned like a political tool for reducing contraceptive access. The label is laden with anti-abortion values (even though EC is contraception, not abortion), and it imposes these values on potential users, resulting in barriers to access such as with Burwell v. Hobby Lobby. These three arguments together provide scientific, social, and ethical grounds for the FDA to take the initiate in changing Plan B's drug label.
Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections between mechanistic processes and more fundamental reasons for (or against) medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill (emergency contraception) to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates.
Kevin Elliott and others separate two common arguments for the legitimacy of societal values in scientific reasoning as the gap and the error arguments (respectively, the arguments from underdetermination and from inductive risk). This paper poses two questions: How are these two arguments related, and what can we learn from their interrelation? I contend that we can better understand the error argument as nested within the gap because the error is a limited case of the gap with narrower features. Furthermore, this nestedness provides philosophers with conceptual tools for analyzing more robustly how values pervade science.
Philosophers of science have increasingly become interested in problems of bias in industry-funded science. A consequence of this interest has been tentative suggestions for how to deal with such issues, yet frequently little attention is given to evaluating whether the proposed policies would be successful. We consider a proposal of incorporating citizen stakeholders into scientific research and show via a detailed case study in pharmaceutical regulation that such programs can be co-opted. In closing, we use Holman’s (2015) asymmetric arms race framework to understand what happened in this case and as a tool for evaluating policies in industry-funded science.
Philosophers of science debate the proper role of non-epistemic value judgements in scientific reasoning. Many modern authors oppose the value free ideal, claiming that we should not even try to get scientists to eliminate all such non-epistemic value judgements from their reasoning. W. E. B. Du Bois, on the other hand, has a defence of the value free ideal in science that is rooted in a conception of the proper place of science in a democracy. In particular, Du Bois argues that the value free ideal must be upheld in order to, first, retain public trust in science and, second, ensure that those best placed to make use of scientifically acquired information are able to do so. This latter argument turns out to relate Du Bois’ position on the value free ideal in science to his defence of epistemic democracy. In this essay I elaborate, motivate, and relate to the modern debate, Du Bois’ under-appreciated defence of the value free ideal.
There has been much debate regarding levonorgestrel emergency contraception's (LNG-EC's) method of action since 1999 when the Food and Drug Administration first approved its use. Proponents of LNG-EC have argued that they have moral certitude that LNG-EC works via a non-abortifacient mechanism of action, and claim that all the major scientific and medical data consistently support this hypothesis. However, newer medical data serve to undermine the consistency of the non-abortifacient hypothesis and instead support the hypothesis that preovulatory administration of LNG-EC has significant potential to work via abortion. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room protocols. In the future, technology such as the use of early pregnancy factor may have the potential to quantify how frequently preovulatory LNG-EC works via abortion.
Lay Summary: How Plan B (levonorgestrel emergency contraception) works has been vigorously debated ever since the Food and Drug Administration approved it in 1999. Many doctors and researchers claim that it has either no—or at most—an extremely small chance of working via abortion. However, the latest scientific and medical evidence now demonstrates that levonorgestrel emergency contraception theoretically works via abortion quite often. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room rape protocols.
In the interests of promoting the health and wellbeing of their foetuses, pregnant women are subject to imperatives which expect them to engage in an intense ascetic regime of self-regulation and disciplining of their bodies. This review article draws upon scholarship from the humanities and social sciences on pregnancy, foetal personhood and risk to explain why, at this particular moment in the history of western societies, pregnant women and their foetuses are such potent focal points for regulation, monitoring and control. It is argued that in recent years the foetus has become fetishised as a precious body to the exclusion of the pregnant woman's needs and rights. Biomedical technologies have played an important role in the construction of the contemporary foetal body and the meanings which surround it, as have the discourses and practices of neoliberal politics and risk society.
This book discusses how facts travel, and when and why they sometimes travel well enough to acquire a life of their own. Whether or not facts travel in this manner depends not only on their character and ability to play useful roles elsewhere, but also on the labels, packaging, vehicles and company that take them across difficult terrains and over disciplinary boundaries. These diverse stories of travelling facts, ranging from architecture to nanotechnology and from romance fiction to climate science, change the way we see the nature of facts. Facts are far from the bland and rather boring but useful objects that scientists and humanists produce and fit together to make narratives, arguments and evidence. Rather, their extraordinary abilities to travel well shows when, how and why facts can be used to build further knowledge beyond and away from their sites of original production and intended use.
Criticism plays an essential role in the growth of scientific knowledge. In some cases, however, criticism can have detrimental effects; for example, it can be used to "manufacture doubt" for the purpose of impeding public policy making on issues such as tobacco consumption and greenhouse gas emissions. In this paper, we build on previous work by Biddle and Leuschner who argue that criticism that meets certain conditions can be epistemically detrimental. We extend and refine their account by arguing that such criticism can be epistemically corrupting—it can create conditions that are conducive to the development of epistemic vice by agents operating within them.
Several empirical studies purportedly demonstrate the existence of a scientific consensus on climate change. Such studies have been pursued as a response to concerns that private industries and think tanks have "manufactured" public doubt and derailed regulatory policies. While there is overwhelming evidence for anthropogenic global warming, studies aiming to empirically establish the existence of consensus rely on several problematic assumptions about the nature of consensus and the role of consensus in policy making. Even more worrisome, reinforcing such assumptions in public may actually undermine, rather than increase, trust in climate science.
At each stage of inquiry, actions, choices, and judgments carry with them a chance that they will lead to mistakes and false conclusions. One of the most vigorously discussed kinds of epistemic risk is inductive risk-that is, the risk of inferring a false positive or a false negative from statistical evidence. This chapter develops a more fine-grained typology of epistemic risks and argues that many of the epistemic risks that have been classified as inductive risks are actually better seen as examples of a more expansive category, which this paper dubs "phronetic risk." This more fine-grained typology helps to show that values in science often operate not exclusively at the level of individual psychologies but also at the level of knowledge-generating social institutions.
This book makes the contemporary philosophical literature on science and values accessible to a wide readership. It focuses on two questions: What are the major ways in which scientific reasoning can be influenced by values? and How can we tell whether those influences are appropriate or not? To address these questions, it examines case studies from a variety of research areas, including climate science, anthropology, chemical risk assessment, ecology, neurobiology, biomedical research, and agriculture. These cases show that the value-free ideal for science is problematic; values have important roles to play in identifying research topics, choosing research questions, determining the aims of inquiry, responding to uncertainty, and deciding how to communicate information. The book argues that values can influence science in these ways without harming scientific objectivity-in fact, making value judgments more explicit actually promotes objectivity. In place of the value-free ideal, the scientific community should strive to meet three conditions for addressing values appropriately: (1) the influences of values should be made transparent; (2) values should reflect ethical and social priorities; and (3) values should be scrutinized via processes of engagement that incorporate multiple stakeholders. The book explores multiple engagement strategies that can help bring values to light and subject them to critical scrutiny.
Since the middle of the twentieth century, there has been a heated debate between evolutionists and antievolutionists regarding whether or not evolution is a ‘fact’. The debate has spawned a number of court cases involving antievolutionists describing evolution as a ‘theory, not a fact’. An analysis of the ‘fact of biological evolution’ discourse reveals several overarching agreements among its advocates, but also a contradictory morass of positions regarding how scientific theories, hypotheses and facts interrelate, how these terms are related to biological evolution, what a scientific fact is, and how science popularizers use the scientific and public vernaculars. The formation, structure and development of the discourse is assessed through a Foucauldian discourse analysis, as well as through the lens of Gieryn’s conceptions of public science and cultural cartography.
What is misogyny? And (why) is it still occurring? This book explores the logic of misogyny, conceived in terms of the hostilities women face because they are living in a man’s world, or one that has been until recently. It shows how misogyny may persist in cultures in which its existence is routinely denied-including the United States, Australia, and the United Kingdom, which are often alleged to be post-patriarchal. Not so, Down Girl argues. Misogyny has rather taken particular forms following the advent of legal equality, obligating women to be moral “givers,” and validating a sense of entitlement among her privileged male counterparts. Many of rape culture’s manifestations are canvassed-from the ubiquitous entreaty “Smile, sweetheart!” to Donald Trump’s boasts of grabbing women by the “pussy,” which came to light during his successful 2016 presidential campaign; from the Isla Vista killings in California to the police officer in Oklahoma who preyed on African American women with criminal records, sexually assaulting them in the knowledge they would have little legal recourse; from the conservative anti-abortion movement to online mobbings of women in public life, deterring the participation therein of all but the most privileged and well-protected. It is argued on this basis that misogyny often takes the form of taking from her what she is (falsely) held to owe him, and preventing her from competing for positions of masculine-coded power and authority. And he, in turn, may be held to owe her little.
This article motivates a shift in certain strands of the debate over legitimate roles for nonepistemic values in scientific practice from investigating what is involved in taking cognitive attitudes like acceptance toward an empirical hypothesis to looking at a social understanding of assertion, the act of communicating that hypothesis. I argue that speech act theory’s account of assertion as a type of doing makes salient legitimate roles nonepistemic values can play in scientific practice. The article also shows how speech act theory might provide a framework for fruitfully extending aspects of the social and pragmatic turns in the philosophy of science. © 2017 by the Philosophy of Science Association. All rights reserved.
In France, contraception was legalized in 1967, resulting in the rapid medicalization of contraceptive practices (Leridon et al. 2002). The Abortion Act followed in 1975, allowing first trimester abortions to be performed upon a woman’s request. Today, a vast majority of French women use highly effective methods of contraception (Bajos et al. 2004a). According to the results of a population-based study of a cohort of 2,863 women of reproductive age conducted in 2000 (the COCON study), it is estimated that only 3 percent of women potentially at risk of an unintended pregnancy do not use contraception (Bajos et al. 2004a). The same study showed that 61 percent of contraceptive users rely on oral contraceptive pills (OCPs) and 21 percent on the intrauterine device (IUD) (Bajos et al. 2004a). At the same time, unintended pregnancies remain frequent: one in three pregnancies is reported to be unintended, with 62 percent of these ending in an abortion (Bajos et al. 2004a, 2004b). At 14.8 per 1,000 women aged 15–49, the abortion rate in France is among the highest in Western Europe (Vilain 2009). While this rate has remained relatively stable since the mid-1980s for women above 25 years of age, data suggest a slight increase among younger women since the late 1990s (Vilain 2009).
Requiring a physician's prescription for hormonal emergency contraceptive pills makes no sense. Unintended pregnancies remain endemic in the United States, and wider use of emergency contraceptive pills could substantially help. However, the prescription requirement poses an unnecessary barrier to prompt, effective use of this preventive therapy. According to the Durham‐Humphrey Amendment of 1951, the default option for all new drugs is, in principle, over‐the‐counter, unless a drug is addictive or dangerous when self‐administered. Clearly, hormonal emergency contraception is neither of these. Emergency contraceptive pills meet all the customary criteria for over‐the‐counter use: low toxicity, no potential for overdose or addiction, no teratogenicity, no need for medical screening, self‐identification of the need, uniform dosage, and no important drug interactions. The Food and Drug Administration is authorized, and, by its own regulations, should be required to switch hormonal emergency contraception to over‐the‐counter status without delay. The current prescription requirement is not only gratuitous but also harmful to women's health because it impedes access to this important therapy.
Scholars in philosophy, law, economics and other fields have widely debated how science, environmental precaution, and economic interests should be balanced in urgent contemporary problems, such as climate change. One controversial focus of these discussions is the precautionary principle, according to which scientific uncertainty should not be a reason for delay in the face of serious threats to the environment or health. While the precautionary principle has been very influential, no generally accepted definition of it exists and critics charge that it is incoherent or hopelessly vague. This book presents and defends an interpretation of the precautionary principle from the perspective of philosophy of science, looking particularly at how it connects to decisions, scientific procedures, and evidence. Through careful analysis of numerous case studies, it shows how this interpretation leads to important insights on scientific uncertainty, intergenerational justice, and the relationship between values and policy-relevant science.
This book in the philosophy of law and risk assessment is concerned with the topic of the standards of evidence in legal proceedings and regulatory decisions regarding the toxicity of chemicals. The book argues that the scientific and statistical criteria usually used to determine whether substances are toxic are too rigorous and time-consuming for evidentiary purposes in tort cases and for regulation. The result is the under-regulation of toxic substances and the under-compensation of plaintiffs in tort cases. The book proposes the evidential standards now used should be evaluated with the purposes of the law in mind.
Há um conjunto de valores, comumente denominados cognitivos, epistêmicos ou científi cos, que com frequência são considerados informativos do bom juízo científi co, quando a evidência se esgota. Contrastando esses valores com um conjunto alternativo, delineado no trabalho de cientistas, historiadoras e fi lósofas feministas, é possível mostrar como a dependência desses valores chamados científi cos tem consequências sociais problemáticas. O artigo examina a valencia social diferencial dos dois conjuntos de valores, argumenta que nenhum dos dois deve ser considerado como dando as condições de produ- ção da verdade e propõe que ambos pertencem a um coleção (provavelmente maior) de heurísticas cuja conveniência depende das características da investigação particular na qual são empregadas
This book examines a variety of ways in which societal values can be more effectively integrated into the numerous judgments associated with policy-relevant environmental research. It provides a detailed analysis of contemporary research on the hypothesis of hormesis (i.e., beneficial biological effects caused by low-dose exposure to pollutants that are ordinarily toxic). On the basis of this analysis, as well as shorter case studies of endocrine disruption and multiple chemical sensitivity, the book proposes three lessons. First, university conflict-of-interest policies are significantly limited in their ability to prevent interest groups from "hijacking" academic research on sensitive policy-relevant topics. Therefore, alternative strategies are needed to preserve science that serves the public interest. Second, concerned citizens and policy makers need to more carefully determine the most appropriate forms of broadly based deliberation to be employed in response to specific areas of sensitive, policy-relevant research. Third, the principle of informed consent, which currently provides guidance in the medical field, suggests a promising ethical framework that can help environmental scientists who disseminate debated findings to the public. Throughout, the book highlights many of the crucial ethical and societal questions surrounding research on the hormesis hypothesis. It thereby constitutes the first book-length manuscript to provide guidance to the concerned citizens, industry groups, scientists, and policy makers who are exploring ways to respond to this phenomenon.
Introduction In the late 1980s, planning began for what would become the United Nations Conference on Environment and Development in Rio de Janeiro, known informally as the Earth Summit. Scientists had called attention to the planetary-scale impacts of human activities: acid rain, ozone depletion, deforestation, biodiversity loss, and now global warming. The latter had come to public attention as the United Nations Environment Programme and the World Meteorological Society joined forces in 1988 to form the Intergovernmental Panel on Climate Change (IPCC) to evaluate the scientific evidence and suggest possible remedies. Scientists had long predicted that increased greenhouse gases from burning fossil fuels would change the chemistry of the atmosphere in ways that could affect global climate, and these predictions were apparently starting to come true. As heat waves scorched the American Midwest, world-renowned climate modeler James Hansen declared in testimony to the U.S. Congress that our Earth had entered a long-term warming trend and that human-made greenhouse gases almost surely were responsible. 1988 was also the year that George H. W. Bush was elected president of the United States, and during his election campaign, he had pledged to combat the greenhouse effect with the “White House effect” – to bring the power of the presidency to bear on the issue of global warming – and to convene a conference on global environmental issues in his first year in office. But like many campaign promises, this one went unfulfilled. One, two, and then three years went by. As June 1992 – the date of the Rio summit – approached and 108 heads of state, 2,400 representatives of nongovernmental organizations (NGOs), and more than 10,000 on-site journalists made plans to converge in Rio (along with 17,000 other individuals who would convene in a parallel NGO forum), it was unclear whether the U.S. president would even attend the meeting.
Over the last twenty or so years, it has become standard to require policy makers to base their recommendations on evidence. That is now uncontroversial to the point of triviality—of course, policy should be based on the facts. But are the methods that policy makers rely on to gather and analyze evidence the right ones? In Evidence-Based Policy, Nancy Cartwright, an eminent scholar, and Jeremy Hardie, who has had a long and successful career in both business and the economy, explain that the dominant methods which are in use now—broadly speaking, methods that imitate standard practices in medicine like randomized control trials—do not work. They fail, Cartwright and Hardie contend, because they do not enhance our ability to predict if policies will be effective.
The prevailing methods fall short not just because social science, which operates within the domain of real-world politics and deals with people, differs so much from the natural science milieu of the lab. Rather, there are principled reasons why the advice for crafting and implementing policy now on offer will lead to bad results. Current guides in use tend to rank scientific methods according to the degree of trustworthiness of the evidence they produce. That is valuable in certain respects, but such approaches offer little advice about how to think about putting such evidence to use. Evidence-Based Policy focuses on showing policymakers how to effectively use evidence. It also explains what types of information are most necessary for making reliable policy, and offers lessons on how to organize that information.
The ‘death of evidence’ issue in Canada raises the specter of politicized science, and thus the question of what role social values may have in science and how this meshes with objectivity and evidence. I first criticize philosophical accounts that have to separate different steps of research to restrict the influence of social and other non-epistemic values. A prominent account that social values may play a role even in the context of theory acceptance is the argument from inductive risk. It maintains that the more severe the social consequences of erroneously accepting a theory would be, the more evidence is needed before the theory may be accepted. However, an implication of this position is that increasing evidence makes the impact of social values converge to zero; and I argue for a stronger role for social values. On this position, social values (together with epistemic values and other empirical considerations) may determine a theory’s conditions of adequacy, which among other things can include considerations about what makes a scientific account unbiased and complete. I illustrate this based on recent theories of human evolution and the social behaviour of non-human primates, where some of the social values implicated are feminist values. While many philosophical accounts (both arguments from inductive risk and from underdetermination) conceptualize the relevance of social values in terms of making inferences from evidence, I argue for the need for a broader philosophical framework, which is also motivated by issues pertaining to scientific explanation.
In a recent paper, Gregor Betz has defended the value-free ideal: "the justification of scientific findings should not be based on non-epistemic (e.g. moral or political) values"against the methodological critique, by reference to the work of the International Panel on Climate Change (IPCC). This paper argues that Betz's defence is unsuccessful. First, Betz's argument is sketched, and it is shown that the IPCC does not avoid the need to "translate" claims. In Section 2, it is argued that Betz mischaracterises the force of the methodological critique. Section 3 shows why the methodological critique still applies to the work of the IPCC even on a refined version of Betz's argument. Section 4 then considers an alternative way of defending the work of the IPCC which is in-line with, but does not clearly vindicate, the value-free ideal.
[Claire Poppe - STS 901 - Fall 2006]
Fleck focuses on the cognitive and social structures idea and fact development and acceptance.
- All ideas stem from "proto-ideas" - hazy, unspecific, unscientific concepts accepted as truth in their time period and existing in a socio-cognitive system.
- The social structure involved in cognition is conceived as the relationship between:
1) the knowing subject (individual)
2) the object to be known (objective reality)
3) the existing fund of knowledge (provided by the thought collective).
- The thought collective is a community of persons mutually exchanging ideas; it is the bearer of collective knowledge and the historical developer of knowledge. The individual's role is to decide whether results fit within the conditions specified by the collective. In this, he/she is influenced by the "thought style," an ambiguous cloud which directs perception and limits the options for interpretation without the perceiver being aware that they are being influenced.
- A scientific fact is a signal of resistance opposing free, arbitrary thinking. Facts are 1) in line with the interests of the collective, 2) accepted by the general membership of the collective, and 3) expressed in the style of the collective.
- Truth is only true within a single collective. It changes as collectives gradually change with the incorporation/adaptation or rejection of challenges to the thought style.
- Within a thought collective, there is a hierarchy consisting of two different groups:
a) Esoteric: a small group of experts with specialized knowledge who develop exoteric, popular knowledge
b) Exoteric: a larger, more "popular" group that creates public opinion, though not the entire public
- Categories of science from more exoteric to esoteric, more concrete to more flexible:
a) Popular science: attractive, lively, readable, artificially simplified science in which facts are reality and truth is objective
b) Vademecum science: a closed, organized system of the "commonly held" view of science where facts become fixed
c) Journal science: a personal, cautious and modest system open to contradictions and explorations
The ideal of value free science states that the justification of scientific findings should not be based on non-epistemic (e.g. moral or political) values. It has been criticized on the grounds that scientists have to employ moral judgements in managing inductive risks. The paper seeks to defuse this methodological critique. Allegedly value-laden decisions can be systematically avoided, it argues, by making uncertainties explicit and articulating findings carefully. Such careful uncertainty articulation, understood as a methodological strategy, is exemplified by the current practice of the Intergovernmental Panel on Climate Change (IPCC).
Key findings: Data from the 2006-2010 National Survey of Family Growth In 2006-2010, among sexually experienced women aged 15-44, roughly one in nine (11% or 5.8 million) women had ever used emergency contraception, up from 4.2% in 2002. Most women who had ever used emergency contraception had done so once (59%) or twice (24%). Young adult women aged 20-24 were most likely to have ever used emergency contraception; about one in four had done so (23%). Almost 1 in 5 never-married women (19%), 1 in 7 cohabiting women (14%), and 1 in 20 currently or formerly married women (5.7%) had ever used emergency contraception. About one in two women reported using emergency contraception because of fear of method failure (45%), and about one in two reported use because they had unprotected sex (49%).
The U.S. Food and Drug Administration is the most powerful regulatory agency in the world. How did the FDA become so influential? And how exactly does it wield its extraordinary power? Reputation and Power traces the history of FDA regulation of pharmaceuticals, revealing how the agency's organizational reputation has been the primary source of its power, yet also one of its ultimate constraints. Daniel Carpenter describes how the FDA cultivated a reputation for competence and vigilance throughout the last century, and how this organizational image has enabled the agency to regulate an industry as powerful as American pharmaceuticals while resisting efforts to curb its own authority. Carpenter explains how the FDA's reputation and power have played out among committees in Congress, and with drug companies, advocacy groups, the media, research hospitals and universities, and governments in Europe and India. He shows how FDA regulatory power has influenced the way that business, medicine, and science are conducted in the United States and worldwide. Along the way, Carpenter offers new insights into the therapeutic revolution of the 1940s and 1950s; the 1980s AIDS crisis; the advent of oral contraceptives and cancer chemotherapy; the rise of antiregulatory conservatism; and the FDA's waning influence in drug regulation today. Reputation and Power demonstrates how reputation shapes the power and behavior of government agencies, and sheds new light on how that power is used and contested.
The paper addresses the question of how different types of evidence ought to inform public health policy. By analysing case studies on obesity, the paper draws lessons about the different roles that different types of evidence play in setting up public health policies. More specifically, it is argued that evidence of difference-making supports considerations about 'what works for whom in what circumstances', and that evidence of mechanisms provides information about the 'causal pathways' to intervene upon.
Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists' willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications. Religious affiliation significantly predicted pharmacists' willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists' willingness to distribute infertility medications. Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses. Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike. The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.
The role of science in policymaking has gained unprecedented stature in the United States, raising questions about the place of science and scientific expertise in the democratic process. Some scientists have been given considerable epistemic authority in shaping policy on issues of great moral and cultural significance, and the politicizing of these issues has become highly contentious. Since World War II, most philosophers of science have purported the concept that science should be âvalue-free.â In Science, Policy and the Value-Free Ideal, Heather E. Douglas argues that such an ideal is neither adequate nor desirable for science. She contends that the moral responsibilities of scientists require the consideration of values even at the heart of science. She lobbies for a new ideal in which values serve an essential function throughout scientific inquiry, but where the role values play is constrained at key points, thus protecting the integrity and objectivity of science. In this vein, Douglas outlines a system for the application of values to guide scientists through points of uncertainty fraught with moral valence. Following a philosophical analysis of the historical background of science advising and the value-free ideal, Douglas defines how values should-and should not-function in science. She discusses the distinctive direct and indirect roles for values in reasoning, and outlines seven senses of objectivity, showing how each can be employed to determine the reliability of scientific claims. Douglas then uses these philosophical insights to clarify the distinction between junk science and sound science to be used in policymaking. In conclusion, she calls for greater openness on the values utilized in policymaking, and more public participation in the policymaking process, by suggesting various models for effective use of both the public and experts in key risk assessments.
Sumario: Risk and rationality -- Science against the people -- Rejecting reductionist risk evaluation: the case for redefining rationality -- Objectivity and values in risk evaluation: why we need a procedural account of rationality -- Five dilemmas of risk evaluation: why we need a new framework for rational risk evaluation -- Perceived risk and the expert-judgment strategy: the case for a negotiated account of risk and rationality -- Democracy and the probabilistic strategy: the case for a populist account of risk and rationality -- Uncertainty and the utilitarian strategy: the case for a maximim account of risk and rationality -- Uncertainty and the producer strategy: the case for minimizing type-II errors in rational risk evaluation -- Third-World risks and the isolationist strategy: the case for an egalitarian account of rational risk management -- Risk evaluation: methodological reforms -- Risk management: procedural reforms.