Rationalism, Empiricism, and Evidence-Based Medicine: A Call for a New Galenic Synthesis

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of the 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. Next, I review several of the problems that have been identified as resulting from a staunch commitment to empiricism in medical practice. Finally, I conclude that greater epistemological awareness in the medical community would precipitate a Galenic shift toward a more epistemically balanced, scientific approach to clinical research

Role-playing in the elementary school

Thesis (Ed. M.)--Boston University, 1963. Includes bibliographical references (leaves 73-74

Labor market data

A guide to the use and interpretation of labor market data (employment, unemployment, and wages). Important statistical sources are surveyed and their histories outlined.Labor market

Fiscal management in federal democracies : Argentina and Brazil

In shifting to decentralized public finances, a country's central government faces certain fiscal management problems. First, during and soon after the transition, unless it reduces pending or increases its own tax resources, the central government tends to have higher deficits as it shifts fiscal resources to sub-national governments through transfers, revenue sharing, or delegation of tax bases. Reducing spending is hard, not only because cuts are always hard, but because sub-national governments might not take on expected tasks, leaving the central government with a legal or political obligation to continue spending for certain services. Second, after decentralization, the local or state government faces popular pressure to spend more and tax less, creating the tendency to run deficits. This tendency can be a problem if sub-national governments and their creditors expect or rely on bailouts by the central government. Econometric evidence from 32 large industrial and developing countries indicates that higher sub-national spending and deficits lead to greater national deficits. The authors investigate how, and how successfully, Argentina and Brazil dealt with these problems in the 1990s. In both countries, sub-national governments account for about half of public spending and are vigorous democracies in most (especially the largest) jurisdictions. The return to democracy in the 1980s revived and strengthened long-standing federal practices while weakening macroeconomic performance, resulting in unsustainable fiscal deficits, high inflation, sometimes hyperinflation, and low or negative growth. Occasional stabilization plans failed within a few years. Then Argentina (in 1991) and Brazil (in 1994) introduced successful stabilization plans. National issues were important in preventing and then bringing about macroeconomic stabilization, but so were intergovernmental fiscal relations and the fiscal management of sub-national governments. State deficits and federal transfers were often out of control in the 1980s, contributing to national macroeconomic problems. Stabilization programs in the 1990s needed to establish control, and self-control, over sub-national spending and borrowing.National Governance,Public&Municipal Finance,Banks&Banking Reform,Public Sector Economics&Finance,Municipal Financial Management,Urban Economics,National Governance,Banks&Banking Reform,Public Sector Economics&Finance,Municipal Financial Management

Decentralization and fiscal management in Colombia

Colombia's political geography contrasts sharply with its economy. Physical characteristics and guerilla war fragment the country geographically, yet it has a long tradition of political centrism and macroeconomic stability. Recently, with political and economic decentralization, there has been some weakening of macroeconomic performance. The authors explore institutional arrangements that have helped Colombia manage the fiscal aspects of decentralization, despite the country's political problems. Fiscal decentralization proceeded rapidly in Colombia. Education, health, and much infrastructure provision have been decentralized to the departmentos and municipios. Decentralization has led to substantial but not overwhelming problems, both in maintaining fiscal balance nationally ( as resources are transferred of subnational levels) and in preventing unsustainable deficits by the subnational governments. The problems have arisen because central government interference prevents departments from controlling their costs and because of expectations of debt bailouts. Both are legacies of the earlier pattern of management from the center, and some recent changes - especially about subnational debt - may improve matters. Colombia's traditional political process has had difficulty dealing with problems of decentralization because traditional parties are weak in internal organization and have lost de facto rule over substantial territories. The fiscal problems of subnational government have been contained, however, because subnational governments are relatively weak politically and the central government, for the time being, has been able to enforce restrictions on subnational borrowing.Urban Economics,Banks&Banking Reform,Public Sector Economics&Finance,Municipal Financial Management,Public&Municipal Finance,Banks&Banking Reform,National Governance,Public Sector Economics&Finance,Municipal Financial Management,Urban Economics