Science progresses through open disagreement: Rejoinder to Fine (2020).

Most critiques of evidence-based medicine (EBM) focus on the scientific shortcomings of the technique. Social scientists are more likely to criticize EBM for its ideological biases, a criticism that makes sociological sense but is difficult to substantiate. Using evidence from the scientific debate over maternity care in the Netherlands--where nearly one-third of births take place at home--the author shows that research evidence is the product of a researcher's assumptions about the practice in question. In the case of maternity care in the Netherlands, ideological differences about the most appropriate way to give birth--based in the researcher's clinical experience--give rise to irresolvable disagreements about what constitutes evidence and how that evidence is to be interpreted. "Evidence" cannot settle scientific disputes in any simple way. Rather, it becomes a rhetorical justification for whatever particular groups were going to do anyway. Scientific evidence rests on clinical practice, which in turn is rooted in structural arrangements and cultural ideas.

Feijoada is one of the most typical dishes of Brazilian cuisine, commonly made from a mixture of black beans and several cuts of pork and beef. It is served with rice, farofa (toasted, seasoned manioc flour), sauteed collard greens, and sliced oranges, among other side orders. In the most sophisticated recipes it can take more than 30 ingredients, including spices and side dishes. One does not have to be a cook, chef, or expert to distinguish beans—the main ingredient of the dish—from complete feijoada. Marijuana, the popular name of Cannabis sativa, has more than 400 compounds, many of which are named “cannabinoids” (substances that affect receptors carrying the same name) (Pate, 2002). In an analogy with feijoada, Δ9-tetrahydrocannabinol (Δ9-THC), responsible for the psychoactive effects of the drug (Zuardi, 2008), could be the beans. In the early twentieth century, when the active principles of the drug had not yet been isolated, marijuana extracts were marketed by large pharmaceutical companies for a number of indications (Fankhauser, 2002). However, the therapeutic use declined within a few years due to the difficulty in obtaining reproducible effects and to the introduction of other drugs for the same indications of marijuana at that moment. Marijuana extracts have a wide variability in their composition, stability, and potency. Thus, consonant with the principles of the evolution of pharmacotherapy, effort has been put into the development of purer cannabinoid compounds that can be accurately measured, thus reducing the risk of significant undesirable side effects. In the first half of the 1960s the chemical structures of the major cannabinoids were determined by Professor Raphael Mechoulam from Israel, including Δ9-THC. Around 80 cannabinoids have been described to date, with different effects and many with therapeutic potential. Cannabidiol (CBD), for example, which makes up to 40% of marijuana extracts, has several effects opposite to those of Δ9-THC, including anxiolytic and antipsychotic properties (Crippa et al., 2010). Differently from Δ9-THC, the use of CBD alone does not cause the typical effects of marijuana, and Brazilian, American, British, and Israeli groups are in the leading edge of research on the therapeutic potential of this compound (Carlini, 2010). Today, CBD is being tested in Brazil in Parkinson's disease, schizophrenia, social phobia, post-traumatic stress disorder, smoking, epilepsy, depression, and other conditions (Crippa et al., 2010; Schier et al., 2012). It can be said, therefore, that cannabinoids are components of marijuana, but that the two are not synonyms. That is, cannabinoids are not marijuana. Marijuana is the most commonly used illicit drug in many countries, despite evidence showing that it may cause transient psychiatric symptoms and cognitive alterations depending on the dose. Moreover, chronic marijuana use may also cause long-lasting cognitive alterations and trigger the onset of psychiatric disorders in vulnerable individuals, depending on the dose, frequency, and earliness of use (Solowij et al., 2002; Manrique-Garcia et al., 2012), although these findings are still under debate. The marijuana withdrawal syndrome has gained increased recognition and it is known that some individuals may develop dependence (Hasin et al., 2008). Currently available therapeutic interventions—both pharmacological and non-pharmacological—have shown less than optimal efficacy. Modern neuroimaging studies show alterations in brain function with chronic, repeated use of marijuana (Bhattacharyya et al., 2012). Furthermore, clinical complications such as cancer and breathing and immunological problems have also been associated with the use of the drug. However, as cannabis is often smoked in conjunction with tobacco and/or other drugs, the relationship between chronic use and these problems is so far inconclusive (Lader, 2009). Therefore, the effects of chronic marijuana use on health need careful evaluation. The existing evidence about these effects is also confounded and misleading, as it considers marijuana and cannabinoids to be equivalent. All scientific debate concerning the legalization of marijuana should necessarily be informed by empirical data from clinical trials and epidemiological studies. Any debate occurring on a background of political positions, ideological biases and, even worse, personal beliefs will only increase confusion, and postpone concrete decisions. Cannabinoids and drugs that act in the endocannabinoid system have been shown to have a fantastic therapeutic potential and there is reason to believe that they could benefit millions of people worldwide. A better understanding of the mechanisms of action of these compounds, with the ensuing legalization of cannabinoids, would be an outstanding scientific breakthrough, leading to a significant decrease in burden, and improved quality of life for people with many diseases and disorders. Conversely, the debate on the legalization of marijuana for recreational purposes should only take place after society and the scientific community is clearly informed about the potential complications of the drug or its possible low-risk profile. In order to do this, however, it is crucial to separate the wheat from the chaff, beans from feijoada or—in this case—cannabinoids from marijuana.

Search engine results influence the visibility of different viewpoints in political, cultural, and scientific debates. Treating search engines as editorial products with intrinsic biases can help understand the structure of information flows in new media. This paper outlines an empirical methodology to analyze the representation of topics in search engines, reducing the spatial and temporal biases in the results. As a case study, the methodology is applied to 15 popular conspiracy theories, examining type of content and ideological bias, demonstrating how this approach can inform debates in this field, specifically in relation to the representation of non-mainstream positions, the suppression of controversies and relativism.

Affective, but hardly effective: a reply to Gauvin and Rejeski (2001)

Constructing unnecessary barriers to constructive scientific debate: A response to Buss and von Hippel (2018).

This article offers a critical review of past attempts and possible methods to test philosophical models of science against evidence from history of science. Drawing on methodological debates in social science, I distinguish between quantitative and qualitative approaches. I show that both have their uses in history and philosophy of science, but that many writers in this domain have misunderstood and misapplied these approaches, and especially the method of case studies. To test scientific realism, for example, quantitative methods are more effective than case studies. I suggest that greater methodological clarity would enable the project of integrated history and philosophy of science to make renewed progress.

We welcome scientific debate around the recognition of abusive head trauma. The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report concludes, ‘ There is limited...

In their commentary, Caulkins et al. 1 reflect on Nutt and colleagues' recent efforts to develop evidence-based scales to assess the harms of drugs, or to rank drugs on the basis of their harmfulness 2, 3. Caulkins et al. vigorously criticize these efforts as ‘fundamentally flawed both conceptually and methodologically’ as well as ‘misguided in principle and particulars’. We share some aspects of the methodological and conceptual criticisms offered by Caulkins et al. vis-à-vis Nutt et al.'s proposed harm scales. We agree, for example, that it is difficult, and can be empirically counterproductive, to try to reduce the harms of drugs into a single indicator measure. The harms and risks related to drugs are clearly multi-dimensional and occur on a variety of levels, and as such would be better expressed by a harm matrix, as has been suggested by others 4, 5. We ourselves, in an attempt to operationalize definitions of ‘harm’ as a conceptual foundation for empirically measuring ‘harm reduction’, proposed such a multi-dimensional matrix more than a decade ago 6. This proposal emphasized the need for measurements of harm at both individual and social levels, also on different axes differentiating acute and long-term harms. We also emphasize—or reiterate—that it is difficult, if not impossible, to assess, quantify or compare any drug's harm independently of its social context. In other words, the currently perceived, assessed or actual harms of alcohol, tobacco or heroin, as examples, are both influenced and constrained by the (desired and undesired) effects that current regulatory or market systems of control have on them 7. That is, as Caulkins notes, harms (or benefits) are highly dependent upon social milieu. However, having acknowledged these potential limitations in Nutt et al.'s models and the methodological weaknesses, and while agreeing on the need for further scientific debate to refine and advance the science of assessing harms as part of the evidentiary base for policy formulation, we submit that these reservations and concerns are of limited relevance when compared to the current lack of any scientific base for present drug control policy. Our opinion is that these methodological concerns definitely ought not to constitute the grounds for categorical dismissal or rejection as advocated by Caulkins et al. Using our own country, Canada, as an example, it is readily apparent that drug scheduling within the Controlled Drugs and Substances Act (CDSA) 8, 9 or provincial and territorial regulatory control systems have little to no footing in scientific evidence; neither do they follow elementary principles informed by empirical logic. If we assume that public health and welfare should be guiding principles for good and desirable psychoactive substance control policy we would, for example, not expect to see the third most commonly used drug (cannabis) to be scheduled and regulated alongside drugs such as heroin and cocaine, while alcohol and tobacco are not only legally available but are openly traded in Canadian society and cause thousands of cases of deaths and injuries each year 7. In comparison, cannabis consumption has zero directly attributable mortality and relatively little major associated morbidity in the majority of users 10, 11. Historically, drug scheduling in Canada originated as a tool of socio-economic control of non-white minority groups, and hence the original drugs included successively in the drug control schedule were opium, cocaine and cannabis (1908–1925) 12, 13. The conceptual framework laid then, and which persists today, had neither public health, nor pharmacology, nor any attempt of rigorous harm quantification as a foundation. Interestingly, tobacco prohibition was considered briefly in Canada during this period, but not considered feasible given its popularity among the dominant white and Anglo-Saxon middle class 14, 15. Alcohol prohibition was approved in Canada by referendum in the late 19th century, yet was never enacted by the federal government (due mainly to resistance from Quebec), and was later imposed on supply largely as a consequence of World War I 16. Thus from a view of current public health and policy perspectives, applying Nutt's harm scales, flawed and limited as they may be, would constitute a quantum leap of progress towards evidence-based and more rational drug policy in Canada and elsewhere. In applying Nutt's harm scales, drug scheduling and control would, to a substantial extent, be informed by scientific evidence of risk and harms from drugs, rather than rooted in the anachronistic skeletons of socio-economic class and control, which arguably may do as much (or more) harm to public health in Canada as the drugs it is supposed to control 17-19. The benefits from grounding Canadian drug control policy in Nutt et al.'s harm scales could be expected to be tangible until at least after their critics have revised and improved them. None.