Alleviating Epistemic Injustice with Strategies from “Science and Values”

This post by Kevin Elliott unpacks the value disagreements that lie at the heart of many epistemic injustices in health care and policy

One of the reasons that epistemic injustice is challenging to tackle in medical contexts is that it can be difficult to decide how to handle situations where non-specialists challenge the views of the mainstream medical community. In some cases, non-specialists may have very important insights, whereas in other cases, they may be guided by misinformation. It’s understandable that medical experts want to resist misinformation, but how can they tell the difference between the two cases?

In an article published recently in Topoi, I argued that recent scholarship in the philosophy of science could help with tackling this challenge. Philosophers of science working on the topic of “science and values” have been exploring the wide array of value-laden choices that scientists make in the course of their research. These choices are value-laden in the sense that they have consequences for society, but they can’t be settled just by appealing to evidence and logic. When non-specialists disagree with medical experts because they are handling these sorts of value-laden choices differently, it suggests that the non-specialists’ perspectives should be taken seriously and explored further. 

Consider three important kinds of value-laden choices: (1) research questions and framing; (2) background assumptions; and (3) standards of evidence. First, non-specialists might approach problems differently from the mainstream medical community because they are asking different questions. For example, Maya Goldenberg contends that most public health experts who make claims about vaccine safety are focused primarily on their overall costs and benefits for society as a whole. She argues that some parents are unconvinced by the experts’ assurances of safety because they are worried that particular vaccines might pose significant risks to their specific children based on their unique characteristics. The parents might accept that the overall costs and benefits of vaccines are favorable for society as a whole, but they might doubt that the experts have adequately studied the risks of vaccines in all sub-populations.

Second, non-specialists might draw different conclusions than specialists because they adopt different background assumptions. For example, sociologist Gwen Ottinger  describes how communities living near industrial facilities in Louisiana have struggled to convince regulators to take their concerns about air pollution seriously. This is partly because of a difference in background assumptions: according to Ottinger, the regulators assume that they should focus on average pollution levels over an extended period of time (say, 24 hours or more), whereas community members argue that they sometimes experience lasting health effects from short-term spikes in pollution over much shorter periods of time.

Third, specialists and non-specialists might disagree because they demand different amounts or kinds of evidence. For example, sociologist Steven Epstein points out that many AIDS activists criticized the U.S. Food and Drug Administration (FDA) in the 1980s and 1990s for being too slow to approve new drugs. The activists felt that the FDA demanded too much evidence before declaring drugs safe and effective, especially considering that AIDS patients were willing to take risks because they were likely to die otherwise.

When non-specialists make these kinds of choices differently from medical experts, it does not automatically mean that the non-specialists are correct, of course. For example, vaccine-hesitant parents might be asking a question that has already been addressed. For instance, experts may have already assessed the risks to children just like theirs and found them to be insignificant. Or the background assumptions accepted by non-specialists might be highly implausible compared to the background assumptions accepted by the mainstream medical community.

Nonetheless, even in cases where non-specialists make implausible choices, clarifying these differing choices can still foster greater understanding and richer dialogues between medical professionals and non-specialists. By clarifying these choices, philosophers of science can help non-specialists communicate more effectively about why they disagree with professionals, and they can help professionals interpret the perspectives of non-specialists in more sympathetic ways. In some cases, medical professionals might even change their minds. For example, AIDS activists ultimately convinced the FDA to adopt an expedited approval process for some drugs, and they altered the ways some clinical trials were designed.

Admittedly, not all cases will turn out as well as the AIDS case. There will be some cases where those who question mainstream medical views are simply misinformed or operating in bad faith. But in order to promote a medical system that combats epistemic injustice, we need to explore ways to promote dialogue and mutual understanding in the face of disagreement. The philosophy of science can help with this task.

Note: This post is adapted from a post written for the blog of the American Philosophical Association, “Threading the Needle: Can We Respect Local Knowledge While Resisting Misinformation?”

Author bio

Kevin Elliott is a Red Cedar Distinguished Professor in Lyman Briggs College, the Department of Fisheries and Wildlife, and the Department of Philosophy at Michigan State University. His research focuses on the philosophy of science and practical ethics, with an emphasis on the roles that ethical and social values play in scientific research, particularly in the environmental health sciences. His books include Values in Science (Cambridge University Press, 2022) and A Tapestry of Values: An Introduction to Values in Science (Oxford University Press, 2017).

What is Public Engagement with Science?

Public Engagement with Science: Definingthe Project, coauthored by Melissa Jacquart and me, was published with Cambridge University Press in January 2025. This volume represents the culmination of years of Melissa’s and my efforts to explore the contours of what it is for academics to do public-facing work about science.

Engaging the public in science: what does this look like?

Way back in 2017, I received initial approval from my institution, the University of Cincinnati (UC), to develop a Center for Public Engagement with Science. Melissa Jacquart, also a philosopher, soon joined me at UC to co-develop the center. Initially, a lot of the work was identifying patterns in how academic science—broadly construed to include natural and social sciences, as well as other STEM disciplines—interfaces with public life. 

And, while we were interested in engagement opportunities created by the internet, our main focus from the start was how academic science interfaces with the local communities its embedded in. We quickly realized that we want to conduct and support public engagement that is (1) participant-centered, (2) interdisciplinary, and (3) community partnered. So that is the basic recipe for the UC Center for Public Engagement with Science, or PEWS.

One of Melissa’s and my early activities was to host a 2021 workshop convening academics interested in public engagement with public engagement practitioners (supported by NSF Award SES-1946951). Videos of this workshop are available on the PEWS YouTube channel. This newly published Element is our first of two planned publications summarizing our learning from that workshop—and, really, our learning from our years spent laying the groundwork for PEWS.

I like thinking of our Element as a tour of resources for and important considerations bearing on attempts to engage with the public about scientific research. Many academics, including Melissa and me, find themselves wanting to use their academic skills to engage not just with other academics but with public audiences as well. This can be motivated by the desire to share scientific content, to encourage more connections with science, or even to shift scientific research priorities toward topics of public concern. We wanted to create a volume accessible to readers from a wide variety of backgrounds who want a window into getting started with public engagement with science.

In this Element, we consider how public engagement with science is defined and what aims it might have (section 1) and explore the wide range of academic disciplines with resources to offer public engagement with science (section 2). We then consider the aims and techniques of collaborating across disciplines and with practitioners on public engagement initiatives, and we consider university structures that can support public engagement (section 3). We outline a goal-directed approach for developing public engagement with science initiatives (section 4). Finally, we consider the variety of forms public engagement can take and how public engagement can feature in research and teaching efforts (section 5).

Cambridge University Press developed the Elements format of publication to be midway between an academic journal article and a full-length book. Elements come in thematic series, all sharing the same cover illustration, and all curated by a series editor (or coeditors). Our Element is actually the first in a new series, also edited by Melissa and me, Elements in Public Engagement with Science. Together with an interdisciplinary and international Editorial Board, we are commissioning Elements on topics like STEM learning ecosystems, citizen science, children’s engagement in science, indigenous science, and more.  You can learn more about the series at its website.

Public Engagement with Science: Defining the Project is available open access, here: https://doi.org/10.1017/9781009475105

Angela Potochnik is Professor of Philosophy, Head of the Philosophy Department, and Director of the Center for Public Engagement with Science at the University of Cincinnati.​  She is the author of Idealization and the Aims of Science (2017) and Science and the Public (2024), as well as coauthor of Recipes for Science: An Introduction to Scientific Methods and Reasoning (2018, 2nd Ed. 2024) and Public Engagement with Science: Defining the Project (2025). She earned her PhD from Stanford University in 2007. 

How Psychiatrists Navigate the Complexities of Diagnostic Reasoning

 

With mental health problems being more openly discussed in public, and individuals with mental health issues becoming an increasingly important and sometimes critical voice in mental health care, the way psychiatrists practice their craft has also become an object of deeper interest for a broader audience. One central aspect of psychiatric practice is diagnostic reasoning. 

When you visit a psychiatrist because you are suffering, you expect them, among other things, to determine whether you suffer from a mental disorder and, if so, which one. While it's crucial to recognize that this is part of a psychiatrist's job description, what is not trivial is the further question: how exactly does a psychiatrist arrive at the diagnostic conclusions they write in their reports and communicate to their patients? How does the psychiatrist know what the patient’s mental disorder is?

A swift response that someone at least vaguely familiar with psychiatry might give is, “Well, they ask the patients for their symptoms and compare these to the list of mental disorders in the DSM/ICD, which tells them what the diagnosis is,” or something along those lines. Though tempting to close the matter here, it is not that easy. Criteria and symptom lists do not apply themselves to patients; it has to be judged whether they apply to the patient. Furthermore, patients are imperfect sources of information. Imperfect in the sense that they will not automatically and correctly tell you all their symptoms, and sometimes they may claim to have symptoms but misjudge their problems. 

For example, some patients think it is normal to be socially isolated as they have been so for many years, so they will not mention social isolation as one of their problems. On the other hand, patients may say they ruminate about something, while the pattern of cognition that constitutes their “rumination” is more accurately classified as generalized worrying, in the language of psychopathology. These cases show that the process of psychiatric diagnostic reasoning implies more complicated patterns of reasoning and information gathering. A truism for any clinician supporting this is: You can't just pick up a DSM and be good at diagnostics; diagnosing is a skill to learn.

Just picking up the DSM isn't enough; diagnosing is a skill!

If this is so, how does proper psychiatric diagnostic reasoning work? Not many philosophers of psychiatry have attempted to provide a theory of this practical aspect of the epistemology of psychiatry. Some work can be found among scholars committed to the Phenomenological Tradition of psychiatry, some in the works of those focusing on the interpersonal quasi-hermeneutic sense-making processes between clinicians and patients, and finally, some thoughts are to be found among philosophers of psychiatry approaching the field from the perspective of philosophy of science.

In my recent book “How Does The Psychiatrist Know?”, the first book-length treatment of psychiatric diagnostic reasoning, I side with those approaching it from a philosophy of science perspective. I argue we should consider how the procedures of clinical psychiatric diagnostics typically look, i.e., what is taught in many of the central textbooks on psychiatric diagnostics and the standards of the leading psychiatric expert communities. Based on this, psychiatric diagnostic reasoning can largely be seen as a cognitive modelling process, quite similar to the procedures we see in scientific modelling.

For clinicians, philosophers, and anyone else willing to dig through an academic textbook to get an idea of the whole story I put forward, the book is available open access.

 

Adrian Kind is a postdoctoral researcher at the Charité Medical University in Berlin, Germany. He holds a PhD in Philosophy and master degrees in Philosophy as well as Psychology. He is a psychodynamic psychotherapist in advanced training. His main areas of interests are philosophy of psychiatry, philosophy of psychology and philosophy of medicine. He also works on philosophy of sports and philosophy of religion.