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PromotingTranslationalResearchinMedicinethroughDeliberation
GordonR.MitchellandKathleenM.McTigue•
Paperpresentedatthe“Justification,Reason,andAction"Conference
inHonorofProfessorDavidZarefsky
NorthwesternUniversity
Evanston,IL
May29&30,2009
•GordonR.MitchellisAssociateProfessorofCommunicationandDirectoroftheWilliamPitt
DebatingUnionattheUniversityofPittsburgh.KathleenM.McTigueisAssistantProfessorofMedicineandEpidemiologyUniversityofPittsburgh.Portionsofthisresearchwerepresentedearlieratthe12thWakeForestArgumentationConferenceinVenice,Italy,June16‐18,2008.
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PromotingTranslationalResearchinMedicinethroughDeliberation
Abstract
Withtheprojectofdrawinguponprinciplesandconceptualtoolsfromargumentation
theorytoinformthematuringEvidence‐BasedMedicine(EBM)movementwell
underway,thetimeisripetoconsiderthepotentialofdeliberationtoelucidate
researchpathwaysintranslationalmedicine.Whilemany"benchtop‐to‐bedside"
researchpathwayshavebeendevelopedin"TypeI"translationalmedicine,vehiclesto
facilitate"TypeII"translationthatconvertscientificdataintoclinicalandcommunity
interventionsdesignedtoimprovethehealthofhumanpopulationshavereceivedless
attention.Astheselatterformsoftranslationalmedicineimplicatesocial,political,
economicandculturalfactors,theyrequire"integrative"researchstrategiesthatblend
insightsfrommultiplefieldsofstudy.Thisessayconsidershowargumentation
theory'sepistemologicalflexibility,audienceattentiveness,andheuristicqualities
yieldconceptualtoolsandprincipleswithpotentialtofosterinter‐disciplinary
exchange,helpresearchteamspercolatecogentarguments,andcultivatephysician‐
citizenship,therebypromotingTypeIItranslationalmedicine.
KEYWORDS:translationalresearch,argumentation,rhetoric,Isocrates,
hypothesis‐testing,evidence‐basedmedicine,EBM,publichealth.
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PromotingTranslationalResearchinMedicinethroughDeliberation
TheprecariousstateoftheUShealthcaresystemhasstimulatedmuch
reflectiononbetterwaystodeliverhigh‐quality,lower‐costcaretomorepeople.
Medicalscience,inparticular,hasbeenlookedtoasapotentialsourceofsolutionsin
thisregard.Indeed,thenation'sstrongmedicalresearchinfrastructurehasan
impressivetrackrecordofachievementinbasicscience.Butinrawform,scientific
dataconferlittlebenefittophysicians,patients,andtaxpayers.Toachievefullpractical
impact,scientificfindingsmustbeconverted,consistentlyandsustainably,into
concreteinterventionsthatimprovehealthoutcomes.
Seeinganeedforimprovementinthischallengeofconvertinggrowthof
scientificknowledgeintobetterqualityhealthcare,theUSmedicalestablishmenthas
developedmajorinitiativesdesignedtopromoteevidence‐basedmedicine(EBM)and
translationalresearch.Bothinitiativesfeaturesignificantpointsofintersectionwith
communicationscholarship.InthecaseofEBM,ateamofCanadianscholarshas
launchedasignificantresearchprogramdesignedtorefinetheEBMapproachusing
argumentationtheory,whileleadersinthenascentfieldoftranslationalresearch
increasinglycallforinter‐disciplinaryresearchteamspursuingtranslationalmedicine
tointegrateexpertiseincommunication.WiththeU.S.healthcaresysteminastateof
flux,thetimeisripeforcommunicationscholarstosurveythelandscapeandassess
howtheymightplayaproductiveroleinthisimportantconversation.
Evidence‐BasedMedicine
As"thehardartofsoftscience,"1medicinefacesadifficultjugglingact.Its
practitionersareexpectedtomakedecisionssystematically,yetalsoadaptjudgments
tofitlocalexigencies.Formuchofhumanhistory,themedicalprofessionsoughtto
strikeabalancebetweenthesetwinobjectiveswitha"practicemakesperfect"
approach.Physicianstrainedtogether,withthepresumptionthatthroughmultiple
1MilosJenicek,"TheHardArtofSoftScience:Evidence‐BasedMedicine,ReasonedMedicine,or
both?,"JournalofEvaluationinClinicalPractice,12(2006):410.
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repetitionofjointcasemanagement,seniordoctors'practicalwisdomandclinical
insightwouldtransfertotheirmorejuniorcolleagues.Forthemostpart,thisdirect
instructionmodelhasservedmedicinewell.Yetthedevelopmentofmodernscience,
especiallybranchesofinquirydirectlyrelatedtomedicinesuchasbiologyand
chemistry,haspromptedcallsfor"evidence‐based"approachesthatwouldbring
scientificfindingstobearmoredirectlyonmedicalpractice.
Theincorporationofobjectivepopulation‐basedevidenceintowesternclinical
carewasinitiallyadvocatedinprominentfashionbyPierreLouis(1787‐1872),a
Parisianphysicianwhoderivedclinicalinsightfromsystematicpatientobservations.2
Hispioneeringworkaddressedthebenefitsandharmsofthethenstandardpracticeof
blood‐letting,byexaminingthefeaturesandoutcomesofgroupsofpatients.3Louis’
“numericalmethod”attractednumerousfollowers.Someofhisstudentsformedthe
SocietyforMedicalObservationinParis,othersfoundedtheStatisticalSocietyin
London,andanothergrouphelpedestablishtheAmericanStatisticalsociety.4Yet
Louis'approachremainedcontroversialanddidnotgainamajorfootholdinthe
teachingandpracticeofmedicine.5
PublicinvestmentinhealthcareresearchafterWorldWarIIresultedinasurge
inbasicsciencethateventuallyyieldedmyriadrandomizedcontrolledtrials,butstill
leftagapbetweenevidenceandpractice.Asaresult,bytheearly1990s,therewasa
pressingneedtounderstandwhichpotentialinterventionswork,andhowwell.6
Steppingintothisbreach,agroupofresearchersatMcMasterUniversitylaunchedin
2D.L.Sackett,Evidence‐BasedMedicine:HowtoPracticeandTeachEBM,2ded.(Edinburgh:
ChurchillLivingstone,2000);M.BestandD.Neuhauser,"PierreCharlesAlexandreLouis:MasteroftheSpiritofMathematicalClinicalScience,"QualityandSafetyinHealthCare,14(December2005):462‐464;andP.K.Rangachari,"Evidence‐BasedMedicine:OldFrenchWinewithaNewCanadianLabel?,"JournaloftheRoyalSocietyofMedicine,90(May1997):280‐284.
3Rangachari,"OldFrenchWine";andAlfredoMorabia,"InDefenseofPierreLouiswhoPioneeredtheEpidemiologicalApproachtoGoodMedicine,"JournalofClinicalEpidemiology,62(January2009):1‐5.
4BestandNeuhauser,"MasteroftheSpirit."5Rangachari,"OldFrenchWine."6A.Levin,"TheCochraneCollaboration,"AnnalsofInternalMedicine,135(2001):309‐312.
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1992aresearchprogramunderthebanner"evidence‐basedmedicine."7Concurrently,
agroupofBritishresearchersformedtheCochraneCollaboration,“toprepare,
maintainanddisseminatesystematicreviewsoftheeffectsofhealthcare
interventions.”8Thenewfieldofevidence‐basedmedicine(EBM)gainedtraction
rapidly,restructuringhowclinicaldecision‐makingistaughtandpracticedacross
diversedisciplinaryandgeographicboundaries.9
ArecentsearchoftheNationalLibraryofMedicine(NLM)database,focusing
on“Evidence‐BasedMedicine”asasubjectheadingorkeyword,showsatotalof
35,205articlesmeetingthosesearchcriteria,withadramaticriseinpublishedarticles
intheyearsbetween1990and2008(seeTable1).Duringthissametimeperiod,
evidence‐basedmedicinehasbeenwidelyacceptedasanimportantpartofmedical
education,witheducationalcurriculadevelopedthroughouttheprocessofmedical
training.10TheCommonProgramRequirementsfortheAmericanCollegeforGraduate
MedicalEducation(ACGME),whichgovernsUSresidencyprograms,includesthe
statement:“residentsmustdemonstratetheabilitytoinvestigateandevaluatetheir
careofpatients,toappraiseandassimilatescientificevidence,andtocontinuously
improvepatientcarebasedonconstantself‐evaluationandlife‐longlearning.”11
[InsertTable1abouthere]
7GordonGuyattfortheEvidence‐BasedMedicineWorkingGroup,"Evidence‐BasedMedicine:ANewApproachtoTeachingPracticeofMedicine,"JournaloftheAmericanMedicalAssociation,268(1992):2420‐2425.
8A.Levin,"TheCochraneCollaboration,"AnnalsofInternalMedicine,135(2001):309‐312.9J.F.King,"AShortHistoryofEvidence‐BasedObstetricCare,BestPractice&ResearchClinical
Obstetrics&Gynaecology,19(February2005):3‐14;andH.L.Kennedy,"TheImportanceofRandomizedClinicalTrialsandEvidence‐BasedMedicine:AClinician'sPerspective,"ClinicalCardiology,18(May1999):471‐480.
10MeenakshyK.AiyerandJosephineL.Dorsch,"TheTransformationofanEBMCurriculum:A10‐yearExperience,"MedicalTeacher,30(2008):377‐383;ColinP.WestandFurmanS.McDonald,"EvaluationofaLongitudinalMedicalSchoolEvidence‐BasedMedicineCurriculum:APilotStudy,"JournalofGeneralInternalMedicine,23(July2008);andPhillippDahm,GlennM.Preminger,CharlesD.Scales,Jr.,SusanF.Fesperman,LawrenceL.Yeung,andMarcS.Cohen,"Evidence‐BasedMedicineTraininginResidency:ASurveyofUrologyProgrammeDirectors,"BritishJournalofUrology,103(February2009):290‐293.
11ACGMEBoard,"CommonProgramRequirements:GeneralCompetencies,"ACGMEOutcomeProject,http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf(accessedMay24,2009).
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TheMcMastergrouphasworkedextensivelytopromoteevidence‐based
medicineasakeytoolforclinicaldecision‐making,bypublishingbooks12and
conveningworkshopsonteachingaboutevidence‐basedclinicalpractice.13Because
theMcMasterapproachisconsideredthestandardinanumberofteachinghospitals,
wedrawfromitheretobrieflydescribehowEBMmaybeintegratedwithclinical
practice.14
Attheoutset,itisimportanttorealizethatevidence‐baseddecision‐making
encompassesthreekeyelements:thebestresearchevidence;clinicalexpertise;and
patientvalues.MuchofthepublicdiscussionaroundEBMhasfocusedonthefirstof
theseelements,whichcomprisesabroadarrayofdataspanningbasicscience
research,patient‐centeredclinicaltrials,evaluationofdiagnostictestsorprognostic
markers,andthesafetyoftherapeutic,rehabilitativeandpreventiveregimens.Inthe
EBMapproach,thesedatashouldbeintegratedwiththeclinician’spriorexperiences
andclinicalskills,whichallowhim/hertoidentifyapatient’shealthstate,risksand
benefitsofpotentialinterventions,andpersonalvalues.Thosevalues–theunique
preferences,concernsandexpectationsthatapatientbringstoeachclinicalencounter
–comprisethethirdkeycomponentofanevidence‐basedclinicaldecision.
Onceaclinicalproblemisidentified,theEBMapproachrecommendsthatthe
clinicianuseittodevelopananswerableclinicalquestion,thentrackdownthebest
evidencewithwhichtoanswerthatquestion.Justfindingdataisinsufficient–the
clinicianshouldalsocriticallyappraisetheevidence,assessingitsvalidity,impact,and
applicabilitytothepatientinneed.Thecriticallyappraisedevidenceisthenintegrated
withthephysician’sclinicalexpertiseandthepatient’spersonalhealthstate,values,
andcircumstances.Finallythephysicianshouldreflectontheprocess,andconsider
possiblewaystoimproveitthenexttimeasimilarquestionarises.
12Sackett,Evidence‐BasedMedicine.13McMasterUniversity,"HowtoTeachEvidence‐BasedClinicalPracticeWorkshop,"
http://ebm.mcmaster.ca/.AccessedMay24,2009.14ThefollowingdescriptionofEBMiscondensedfromSackett'sEvidence‐BasedMedicine,the
authoritativesourceonthisissue.
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AnimportantaspectofEBMistherecommendationthatcliniciansformally
considerthequalityoftheevidencethattheyareincorporatingintotheirdecision‐
makingprocess.Cliniciansareaskedtoevaluateboththetypeofevidence(basedon
studydesign)andthemethodsusedtocarryoutthespecificstudy.Oncerelevantdata
aresortedbytype,cliniciansusetheEBMhierarchyofevidenceasakeytoassign
relativeweightstothevarioustypesofdata(seeFigure1).Forexample,for
therapeuticstudies,expertopinionandbackgroundinformationonatopicare
consideredthelowestqualityofevidence.Nextarecasereportsregardingasingle
patient,thenstrongerobservationalstudydesigns,andinthemorepreferredcategory,
randomizedcontrolledtrials(soplacedastherandomizationstepisdesignedto
removepotentialareasofbias).Finally,systematicreviewsormeta‐analysesassessing
theentireliteratureonaclinicaltopicareconsideredoptimalinthechoiceofclinical
evidence,andthusappearatthetopoftheEBMevidencehierarchy.
Itisessentialtonotethatstudytypeisnottheonlyfeatureinvolvedinthe
assessmentofevidencequalityinEBM–cliniciansarealsoaskedtoevaluatethe
specificfeaturesofanindividualstudy(e.g.,itsinternalvalidity),aswellasassessthe
degreetowhichitappliestotheirpatient(e.g.,itsexternalvalidity).Furthermore,the
appropriatestudydesigndifferswiththetypeofclinicalquestion.Forexample,ifthe
clinicianfacesaquestionondiagnosisandscreening,thepreferredevidenceisdrawn
fromcross‐sectionalstudiescomparinganewtestwiththebest‐establishedprior
testingapproach.
[InsertFigure1abouthere]
Argument‐BasedMedicine
TheintegrationofEBMintoclinicalpracticeduringthe1990sprompted
substantialdiscussioninmedicalcirclesandbeyond,muchofitconcerningwhat
CanadiansociologistHarleyDickinsoncallsthe"EBMparadox."15Accordingto
15HarleyD.Dickinson,"Evidence‐BasedDecision‐Making:AnArgumentativeApproach,"
InternationalJournalofMedicalInformatics,51(1998):73.
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Dickinson,thisparadoxarisesfromatensionbetweentwokeytenetsofEBM:1)The
normativeprivilegingofRCTsandsystematicreviewsasevidencegoldstandards;2)
Theprinciplethataphysician'sclinicalexpertiseservesastheultimateauthorityfor
decidingwhetherandhowpracticeguidelinesshouldbeappliedtomatchan
individualpatient'sclinicalstate.If,asDickinsonreasons,"informationderivedfrom
RCTsandsystematicreviewsofRCTsisthe'goldstandard'formakingdecisionsabout
therapythenitisparadoxicaltoalsomaintainthatsuchdatamustalwaysbe
subordinatedtoclinicalexpertiseinclinicaltreatmentdecisions."16
Resolutionofthisparadoxdemandstheoreticalfinesse,anaccountofthe
clinicaldecision‐makingprocessthatacknowledgesthesaliencebothofscientific
evidenceandclinicalexpertise,aswellasheuristicsfordetermininghowtheseinputs
fittogether,especiallyinappliedcontextswheretheyappeartobeintension.Inabid
todevelopsuchheuristics,Dickinsonturnstoargumentationtheory,drawingfromthe
workofBritishphilosopherStephenToulmin,Canadianargumentationscholar
DouglasWaltonandGermancriticaltheoristJürgenHabermas.Notingthatkeyaspects
ofclinicaldecision‐makingmirrorthetypesofreasoningprominentinargumentative
"informallogic,"DickinsonseesopportunitiesheretoanswersomeofEBM's
detractorsbydrawingfromargumentationtheory.
Inparticular,DickinsonsuggeststhatToulmin'sstructuralmodelofargument
providesvaluableheuristicresourcesfortheoristsandpractitionersseekinguseful
answerstotheEBMparadox.Formallogichasonlylimitedutilityinthisregard,
becausediagnosticdecision‐makingtendsnotconformtothehypothetico‐deductiveor
nomological‐deductivemodelsofreasoning.17However,bychartingtheclinical
decision‐makingprocessintermsofToulmin'sdata‐warrant‐claimstructure,18it
becomespossibletodistinguishandidentify"warrant‐using"data(clinical
16Dickinson,"Evidence‐BasedDecision‐Making,"73.17Onthispoint,DickinsoncitesV.Patel,D.A.EvansandD.R.Kaufman,"ACognitiveFramework
forDoctor‐PatientInteraction,"inCognitiveScienceinMedicine:BiomedicalModeling,ed.D.A.EvansandV.L.Patel(Cambridge,MA:MITPress,1989),257‐312.
18StephenToulmin'sTheUsesofArgument(Cambridge:CambridgeUniversityPress,1958)developsamodelforunderstandingargumentpatternsthatresistreductionintothecategoriesofformallogic;seealsoWayneE.Brockriede&DouglasEhninger,"ToulminonArgument:AnInterpretationandApplication,"QuarterlyJournalofSpeech,46(1960):44–53.
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examinations,interviewsanddiagnostictests)from"warrant‐establishing"data
(systematicresearchintotherapeuticefficacyofstandardmedicaltreatments).19In
Toulmin'stheory,therelativesoundnessofargumentscanbeassessedbydetermining
onwhatbasistheirwarrantslinksupportingdatatooverarchingclaims.Whenapplied
toclinicaldecision‐making,DickinsonsaysthisinsightyieldspurchaseontheEBM
paradox,byprovidingforpractitionersheuristicsthatfacilitatesoundabductive
reasoning.
AroundthetimethatDickinson'sarticleappeared,otherconversationswere
takingplaceinCanadathatwouldeventuallystrengthenEBM'slinkwith
argumentationtheory.Oneparticularlyconsequential,cross‐disciplinaryconnection
occurredatMcMasterUniversityinHamilton,Ontario—thewidelyrecognizedsiteof
EBM'sNorthAmericanbirthplaceandlocationwhereMcMasterprofessorsMilos
JenicekandDavidHitchockdevelopedacollaborativeresearchprogram.Ina2005
textbook,Evidence‐BasedPractice:LogicandCriticalThinkinginMedicine(published
bytheAmericanMedicalAssociation),Jenicek,professorofclinicalepidemiologyand
biostatistics,andHitchcock,professorofphilosophy,developedafull‐blowntreatment
ofEBMasanargumentativeprocess.20
TwointroductorystatementspunctuateEvidence‐BasedPractice's
interdisciplinarycharacter.Ina"physician'sforeword,"Harvardprofessorof
ambulatorycareSuzanneFletchersaysthatwithpublicationofthetext,"clinicians,as
wellasmedicalresearchersandhealthplanners,canunderstandbettertheworldsof
'criticalthinking'and'evidence‐basedmedicine'andhowtheyrelatetoclassic
philosophicalthought."21Ina"philosopher'sforeword,"renownedinformallogician
RobertEnnisapplaudsJenicekandHitchcockfortheir"pioneeringdetailedwork,"
singlingitoutasoneofafewrareworksthatpursue"explicitapplication"ofcritical
thinking"inafieldofstudyorpractice."22
19Dickinson,"Evidence‐BasedDecision‐Making,"78.20MilosJenicekandDavidL.Hitchcock,Evidence‐BasedPractice:LogicandCriticalThinkingin
Medicine(Chicago:AMAPress,2005).21SuzanneW.Fletcher,"Physician'sForeword,"inEvidence‐BasedPractice,xv.22RobertH.Ennis,"Philosopher'sForeword,"inEvidence‐BasedPractice,xiii.
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TheemphasisoncriticalthinkinginEvidence‐BasedPracticereflectsthemark
oftheCanadianschoolofargumentationscholarship,ofwhichHitchcockisa
prominentmember.23Canadianinformallogiciansincorporatethepedagogical
conceptofcriticalthinkingtoelucidatehowstudentsandcriticscanoperationalize
Toulmin'sessentialinsightsaboutargumentasanexerciseinmovingfromdatato
claimsusingwarrants.Evidence‐BasedPracticecatalogsnumerousinstanceswhere
modesofmedicalpractice,suchasdoctor‐patientcommunicationandtherenderingof
expertcourtroomtestimony,matchupwithpatternsofreasoningininformallogic.For
eachoftheseinstances,JenicekandHitchcockexplicatehowconceptsandtermsfrom
theirrespectivefieldsoverlap,thenusethesepointsofoverlaptogeneratecritical
thinkingheuristicsadaptedspecificallytothemedicalcontext.
Forinstance,JenicekandHitchcockpointoutthatmedicaldiagnosesand
treatmentdecisionsinvolvedistincttypesofhumanreasoning.Adiagnosisbeginswith
"premises,"suchas"theresultsofaclinicalexamination"andleadstoa"conclusion
thatthepatientdoesordoesnothavethediseaseunderconsideration."Likewise,"the
conclusionofthediagnosticprocessbecomesapremiseleadingtotheconclusionthat
thepatientshouldorshouldnotbetreated,andbywhichtherapeuticmaneuver,such
asdrugs,surgery,supportandsoon."24Sincethispatternofreasoningclosely
resemblesacategoricalsyllogism,JenicekandHitchcockproposethatitcanbe
profitablyunderstood,practiced,andtaughtusingtheoreticalconceptssuchasthe
Toulminmodelofargument.
GiventhestrongtraditioninCanadianinformallogicscholarshipofanalyzing
argumentationbyfocusingonfallacies,orerrorsinreasoning,itisnotsurprisingthat
Evidence‐BasedPracticehighlightshowphysiciansattemptingtoexecutethe
principlesofEBMcanmakemistakesinreasoning.Forexample,JenicekandHitchcock
warnagainsttheposthocfallacy(orfallacyoffalsecause)indiagnosticcontexts(e.g.
23SeeHitchcock'seditedvolume,TheUsesofArgument:ProceedingsofaConferenceat
McMasterUniversity,18‐21May2005(Hamilton:OntarioSocietyfortheStudyofArgumentation,2005);aswellashis“TheSignificanceofInformalLogicforPhilosophy,"publishedintheCanadianjournalInformalLogic,20(2000):129‐138.
24JenicekandHitchcock,Evidence‐BasedPractice,196.
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"anembolismwascausedbyatransoceanicflight,becausethevictimwaswellon
boardingtheplane").25Theyalsopointouthowtheadignorantiamfallacy(some
statementmustbetruebecausethereisnoevidencetodisproveit)canproduce
medicaltreatmenterrors(e.g.regardinguntestedalternativemedicines,"nobodyhas
provedtheydonotwork,sotheymust!").26InEvidence‐BasedPractice,Jenicekand
Hitchcockframetheirpreliminaryworkinthisareabyobserving,"amorecomplete
compilationofanumericallyopen‐endedlistoffallaciesinmedicalreasoningmuststill
beworkedup,"ataskthatJenicekwouldpursueinhisnextmajormonograph.27
In2008,Jenicekpublishedthesole‐authored,Fallacy‐FreeReasoningin
Medicine:ImprovingCommunicationandDecisionMakinginResearchandPractice.28
Onceagain,thisbookusedtheToulminmodelofargumentasastartingpointfor
explainingmedicalreasoningfromthevantagepointofinformallogic.Butratherthan
isolatingargumentativeerrorsbyrelyingexclusivelyonthecatalogofclassical
Aristotelianfallacies(theso‐called"standardmodel"),Jenicektheorizeda
smorgasbordoffallacieswithclevernamesneverbeforefeaturedprominentlyin
argumentationliterature.29Forexample,the"threemenmakeatiger"fallacyoccurs"if
anunfoundedpremiseismentionedandrepeatedbymanyindividuals,thepremise
willbeerroneouslyacceptedasthetruth."Jenicekdrawsthenameforthisfallacynot
fromancientGreekandLatin(asinthestandardmodel),butfromaChineseproverb
aboutreportsofaloosetigercirculatinginKingWei'scapitalcity.Accordingtothe
legend,KingWeiremainsskepticalofthefirsttworeportsabouttheloosetiger.But
whenathirdcivilianechoesthesamereport,thekingchangeshismind(erroneously,
asitturnsout).Jenicekseesparallelmistakesinmedicalreasoning,suchas:"Somany
differentauthorsrecommendthebenefitsofrepeatedenemasthatyoushould
25JenicekandHitchcock,Evidence‐BasedPractice,55.26JenicekandHitchcock,Evidence‐BasedPractice,245.27JenicekandHitchcock,Evidence‐BasedPractice,56.28MilosJenicek,Fallacy‐FreeReasoninginMedicine:ImprovingCommunicationandDecision
MakinginResearchandPractice(Chicago:AMAPress,2008).29Onthe"standardmodel"ofargumentativefallacies,seeC.L.Hamblin,Fallacies(London,
Meuthen,1970.
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considerthisproceduretoo."30ForJenicek,suchabreakdownincriticalthinking
entails"anyuncriticalandnonsystematicreviewoftheliteratureorotherinformation
proclaimedastruthbecauseofitsrepetitionanditsindiscriminateuses."31Jenicek
elaboratesawholemenuofrelated,colorfullynamedfallaciesinthisvein,suchasthe
"if‐by‐whiskey"fallacy,32the"slothfulinduction"fallacy,33andthe"vaguenumberism"
fallacy."34
Inintroductorycomments,Jenicek'ssharesahopeisthathismonographwill
contributeto"reducingerrorsinmedicine"bypromoting"fallacy‐freeclinicaland
communitymedicinereasoninganddecisionmakinginmedicalcareandhealthcare
policysettings."35ThisaimcoincideswithcoretenetsofEBM,since"eventhebest
evidenceintheworldofevidence‐basedmedicinemaybewastedinfallacious
argumentation."36
Jenicekunderscoresthispointbycoininganewterm(withhelpfrominternist
G.Altbbaa),"argument‐basedmedicine,"todescribeanapproachtoEBMmade
possiblebyintegrationofargumentationtheoryintomodesofmedicalreasoning.
AccordingtoJenicek,argument‐basedmedicineis"theresearchandpracticeof
30Jenicek,Fallacy‐FreeReasoninginMedicine,124.31Jenicek,Fallacy‐FreeReasoninginMedicine,124.32If‐by‐whiskeyfallacy:"Presentationofanissueinsuchawaythattherecipientofthe
messagecanagreewithbothsidesoftheissue.ThistypeofopinionpresentationwasoriginallyusedtoreflectuponwhetherthelegalizationofwhiskeyconsumptionmightbeconsideredduringtheProhibitionyearsintheUnitedStates."Medicalcounterpart:"Ifweconsidermorphineasanaddictivesubstanceleadingtodependency,financialandsocialdisruptionoflife,toxicity,andoverdosing,wemustbanitfromuse.Ifwefinditsuseimportantasananalgesicofspecialinterestinthetreatmentofmyocardialinfarction,pulmonaryedema,dyspnea,andotherproblemsinend‐of‐lifecare,wemustsupportitsavailabilityanduse"(Jenicek,Fallacy‐FreeReasoninginMedicine,58).
33Slothfulinductionfallacy:"Theproperconclusionisdenieddespiteevidencetothecontrary."Medicalcounterpart:"Thepatientwehavejustseenforhisfifthworkaccidentandensuinginjuriesinsiststhatthisisjustacoincidence(company'sfault,hishealth,andsoforth)andnothisfault"(Jenicek,Fallacy‐FreeReasoninginMedicine,101).
34Vaguenumberismfallacy:"Offeringvagueandoftenmeaninglessandexaggeratingquantificationsinsteadofrealdata."Medicalcounterpart:"Arepresentativeofapharmaceuticalcompanyvisitingahospitalsays,'Wehaveworkedonthedevelopmentofthisnewdrugforanumberofyears.Wealsoassignedanunusualnumberofresearcherstothisproject.Theresult,thenewdrugIambringingtoyourattentiontoday,isimportantforanumberofreasons"(Jenicek,Fallacy‐FreeReasoninginMedicine,103).
35Jenicek,Fallacy‐FreeReasoninginMedicine,x,xix.36Jenicek,Fallacy‐FreeReasoninginMedicine,105.
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medicineinwhichunderstandinganddecisionsinpatientandpopulationcareare
supportedbyandbasedonflawlessargumentsusingthebestresearchandpractice
evidenceandexperienceasargumentationbuildingblocksinastructured,fallacy‐free
mannerofargumentation."37
AnecdotalevidencesuggeststhatJenicek'sindexofnewfallaciesrepresentsa
realadvanceincriticalthinkingpedagogy.UndergraduatestudentsattheUniversityof
Pittsburghstudyingargumentrespondedwithgreatenthusiasmwhenpresentedwith
someofJenicek'splayfullynamedfallacies.Theyretainedmoreinformationaboutthe
errorsinreasoningunderlyingeachfallacy,andwereabletoapplysuchtheoretical
insightmorereadilytopracticalarguments.Whetherargument‐basedmedicinecan
deliveronitspromisetoimprovehealthoutcomesinthemedicalcontexthingeson
severalfactors,includingwhethermedicalprofessionalsexhibitasimilardegreeof
enthusiasmforlearningfallacies,whether"fallacyfree"reasoningactuallyreduces
harmfulmedicalerrors,andtheextenttowhichreductioninmedicalerrorsresultsin
betteroverallqualitycare.
TheprevioustwosectionselucidatedtheoriginsanddynamicsofEBM,and
detailedhowargumentationtheoryhasbeendeployedinanefforttorefinetheEBM
approach.Ontheirown,thesedevelopmentsshouldpiquetheinterestof
argumentationscholars,asEBMhasquicklyemergedasadominantparadigmfor
medicaldecision‐makinginundertwodecades.Thefactthattwobook‐lengthstudies
blendingEBMandargumentationhavebeenpublishedinthepastfouryearsspeaksto
thetheoreticalfecundityofargumentationasaresearchprogramwithstrongpotential
fortrans‐disciplinarycross‐fertilization.Mighttherebeadditionalopportunitiesfor
similarsortsofcollaborationinthisresearcharea?Inlookingforpossibilities,the
emergentprogramof"translationalresearch"inmedicineisagoodplacetostart.
TranslationalResearch
Whileevidence‐basedmedicinemadestridestowardclosingthegapbetween
basicscienceresearchandclinicalpractice,theconsiderabledepthofthatgapbecame
37Jenicek,Fallacy‐FreeReasoninginMedicine,141.
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apparentthroughoutthe1990s.In2003,theNationalInstitutesofHealthannounced
itsRoadmapInitiative,withagoalof“defin[ing]acompelling,limitedsetofpriorities
thatcanbeactedonandareessentialtoaccelerateprogressacrossthespectrumofthe
institutemissions.”38TheRoadmapincludesthreethemes:
(1)NewPathwaystoDiscovery,addressingtheneedtounderstand
complexbiologicalsystems;
(2)ResearchTeamsoftheFuture,recognizingtheneedforresearchers
tomovebeyondtheirindividualdisciplinesandexplorenew
organizationalmodelsforteamscience;and
(3)ReengineeringtheClinicalResearchEnterprise,focusingonrecasting
theentiresystemofUSclinicalresearch.
Asapartofthisthirdtheme,theNIHmadetherelativelynewfieldof
translationalresearchapriority,allocatingresourcestopromotetraininganddevelop
asupportstructureforthefield.Thefieldof"translationalmedicine"focusesonthe
taskofconvertingbasicscientificdataintopracticalapplicationsthatimprovehuman
healthinappliedsettings.39
TheNIHdefinestranslationalresearchbyisolatingtwoconveyorbeltsdesigned
tobringbasicsciencetoappliedcontexts:“Oneistheprocessofapplyingdiscoveries
generatedduringresearchinthelaboratory,andinpreclinicalstudies,tothe
developmentoftrialsandstudiesinhumans.Thesecondareaoftranslationconcerns
researchaimedatenhancingtheadoptionofbestpracticesinthecommunity.Cost‐
effectivenessofpreventionandtreatmentstrategiesisalsoanimportantpartof
translationalscience.”40
TheInstituteofMedicinehasdescribedtwo“translationalblocks”intheclinical
researchenterprise,whichalignwiththetwoareasoftranslation(Type1or"T1,"and
Type2or"T2")describedintheNIHdefinition.Thefirstoftheseblocks(T1)hinders
38EliasZerhouni,"Medicine:TheNIHRoadmap,"Science,302,(2003):63‐72.39SeeM.E.J.Lean,J.L.Hoek,R.M.Elliot,andG.Schofield,"TranslationalResearch:From
Evidence‐BasedMedicinetoSustainableSolutionsforPublicHealthProblems,"BritishMedicalJournal,337(2008):863
40UnitedStatesNationalInstitutesofHealth,2009Glossary&AcronymList,http://grants.nih.gov/grants/glossary.htm#T(accessedMay24,2009).
15
thetransferofnewunderstandingsofdiseasemechanismsgainedinthelaboratory
intothedevelopmentofnewmethodsfordiagnosis,therapyandpreventionandtheir
firsttestinginhumans.Thesecond(T2),blocksthetranslationofresultsfromclinical
studiesintoeverydayclinicalpracticeandhealthdecisionmaking.Dr.StephenWoolf
ofVirginiaCommonwealthUniversityarguesthatwhilethesecondblockhasbeen
historicallyoverlookeditisactuallyofcriticalimportance.41Forexample,mostdrugs
andinterventionsproducedbyT1researchonlymarginallyimprovetreatment
efficacy.Furthermore,patientsmaybenefitmore(andmorepatientsmaybenefit)if
thehealthcaresystemperformedbetterindeliveringexistingtreatmentsthanin
producingnewones.Inaddition,hepointsoutthatadequateinvestmentinT2isvital
tofullysalvageinvestmentsinT1research.42
Ofnote,T2translation–whichalignscloselywithevidence‐basedmedicine–
includesbothtranslationofknowledgeintopatientcare(e.g.,creatingpatient‐specific
evidenceofclinicaleffectiveness,comparativeeffectivenessofdifferenttreatments,
andthedevelopmentofpracticeguidelines),aswellasstrategiestoaddressmore
distalquestions(e.g.,howtoreliablydeliverevidence‐basedcaretoallpatientsin
diversehealth‐caresettings,inordertoimprovethehealthofbothindividualsand
populations).Particularlyintheareaofobesityanddiabetesprevention,thedistalend
oftranslationhasincreasinglyfocusedonimprovingthehealthofthepopulation,
ratherthanspecificallyaddressingindividuals(patients)incontactwiththehealth‐
caresystem.43
Whilemany"benchtop‐to‐bedside"researchpathwayshavebeendevelopedin
T1translationalmedicinedesignedto,forexample,bringdrugstomarketfollowing
advancesinbasicscience,vehiclestofacilitateT2translationthatconvertscientific
dataintoclinicalandcommunityinterventionsdesignedtoimprovethehealthof
41S.H.Woolf,"TheMeaningofTranslationalResearchandWhyitMatters,"Journalofthe
AmericanMedicalAssociation,299(2008):211‐213.42Woolf,"MeaningofTranslationalResearch."43D.G.Marrero,"TranslatingtheDiabetesPreventionProgram,"inFromClinicalTrialsto
Community:TheScienceofTranslatingDiabetesandObesityResearch(Bethesda,MD:NationalInstitutesofHealthandCentersforDiseaseControlandPrevention,2004),49‐52.
16
humanpopulationshavereceivedlesattention.44Astheseformsoftranslational
medicineimplicatesocial,political,economicandculturalfactors,theyrequire
"integrative"researchstrategiesthatusecross‐disciplinarycommunicationtoblend
insightsfrommultiplefieldsofstudy.45
Inthisareaofresearch,thecentrifugalforcesofprofessionalspecializationand
horizontalknowledgediffusionscatterthepooluponwhichscholarsandpractitioners
drawdata.Simultaneously,centripetalforcesobligethesesamescholarsand
practitionerstosynthesizevastsumsofdiverseinformationandrendercoherent
argumentsoncomplexandmultifacetedissues.Thetaskisdifferentinkindfromsheer
informationprocessing;itdemandsformsofcommunicativedexteritythatenable
translationofideasacrossdifferencesandfacilitateco‐operativeworkbyinterlocutors
fromheterogeneousbackgrounds.Punctuatingthispoint,“[FormerNIHDirectorElias
Zerhouni]acknowledgesthatthereisno'right'modelfortranslationalresearch,buthe
isconfidentthattheNIHwilllearnaboutthebestonesbygivingtheCTSCs[Clinical
andTranslationalScienceCenters]thefreedomtoexploreadiversityofapproaches.”46
Thecommunicationchallengesinplayheremayhelpaccountforthefactthatscholars
advocatingforatranslationalresearchagendainsistthat"communicationtheory"
informeffortstoimplementtheagenda.47
Thechallengeofusingcommunicationtodealwithtensionsbornefromthe
pushandpullofcountervailingcentrifugalandcentripetalepistemologieshasancient
roots.AsJohnPoulakospointsout,"older"SophistssuchasProtagorastaughtGreek
studentsthevalueofdissoilogoi,orpullingapartcomplexquestionsbydebatingtwo
sidesofanissue.48ThefewsurvivingfragmentsofProtagoras'worksuggestthathis
44A.M.Feldman,"DoesAcademicCultureSupportTranslationalResearch?,"Clinicaland
TranslationalScience,1(2008):87‐88.45S.Mallonee,C.Fowler,&G.R.Istre,"BridgingtheGapbetweenResearchandPractice:A
ContinuingChallenge,"InjuryPrevention,12(2006):357‐359.46DeclanButler,"TranslationalResearch:CrossingtheValleyofDeath,"Nature,453(2008):
840‐2.47Woolf,"MeaningofTranslationalResearch,"211‐213.48RosamondKent,Sprague,ed.,TheOlderSophists,2ded.(Indianapolis:Hackett,2001);John
Poulakos,"RhetoricandCivicEducation:FromtheSophiststoIsocrates,"inIsocratesandCivicEducation,ed.TakisPoulakosandDavidJ.Depew(Austin:UniversityofTexasPress,2004),81‐82.
17
notionofdissoilogoistoodfortheprinciplethat"twoaccounts[logoi]arepresent
aboutevery'thing,'opposedtoeachother,"49andfurther,thathumanscould
"measure"50therelativesoundnessofknowledgeclaimsbyengagingingive‐and‐take
wherepartieswouldmakethe"weakerargumentstronger"toactivatethegenerative
aspectofrhetoricalpractice,akeyelementofthesophisticaltradition.51Oneimportant
wrinkleinthiscomparison,however,isthefactthatwhileProtagoras'dissoilogoiwas
dyadicinnature(twoargumentsopposingeachother),manifoldT2translation
projectstendtofeaturemany‐sidedarguments—henceouradaptedneologismpolloi
logoi.52
Inthefollowinggeneration,IsocrateswouldcomplementProtagoras'
centrifugalpushwiththepullofsynérchesthé,acentripetalexerciseof"coming
togetherdeliberatively"tolisten,respond,andformcommonsocialbonds.53Fourth‐
centuryB.C.Athenswasasocietyintumultuoustransition.Earlyinthecentury,
democraticreformsandwidespreadcitizentraininginpublicspeakinginfusedthe
politicalrealmwithnewactors,openingupchannelsofparticipationandtransforming
governmentalinstitutions.Butasthecenturyworeon,thiscentrifugalwaveof
populism,swellingamiddeterioratingeconomicconditions,threatenedtooverwhelm
theAthenianpolity.ItwasagainstthisculturalbackdropthatIsocratesopenedthe
west'sfirstprofessionalschool.Theschool'scurriculumreflectedthestronginfluence
ofProtagoreandissoilogoi,butIsocratesembeddedargumentationwithin
synérchesthé("comingtogetherdeliberately"),abroaderconceptthatheusedflexibly
toexpressinterlockingsensesof1)inquiry,asingroupsconveningtosearchfor
answerstocommonquestionsthroughdiscussion;542)deliberation,withinterlocutors
49EdwardSchiappa,ProtagorasanLogos:AStudyinGreekPhilosophyandRhetoric(Columbia,
SC:UniversityofSouthCarolinaPress,1991),100.50Schiappa,ProtagorasandLogos,117‐133.51Schiappa,ProtagorasandLogos,103‐116.52WeareindebtedtoJohnPoulakosforthisformulation.53EkaterinaHaskins,LogosandPowerinIsocratesandAristotle(Columbia,SC:Universityof
SouthCarolinaPress,1997),88.54Isocrates,Panathenaicus,trans.GeorgeNorlin,vol.2,LoebClassicalLibrary(London:William
Heinemann,1929),14,76.
18
gatheringinapoliticalsettingtodeliberateaboutproposedcoursesofaction;55and3)
allianceformation,aformofcollectiveactiontypicalatfestivals,56orintheexchangeof
pledgesthatdeepensocialties.57Isocratescontrastedhispaideiawiththeapproachof
earlierSophists,whotaughteloquenceasaneutralskilltobeusedforwhateverends
studentssawfit.Instead,Isocrateshighlightedthecentripetalqualitiesofsynérchesthé
asaneducationalantidotetotheincreasinglyselfishandfractiousnatureofAthenian
politics.58Hisaimwastoproducecitizensandleaderswithbroad‐basedknowledgeof
humanaffairs,alongwiththepoliticalvisionandcommunicativeabilitytoexpressthat
knowledgeforthegreatergoodofthepolis.Inshort,Isocratestaughtandpracticedthe
artofusingdeliberationasakindoftranslationmedium,capableofengendering
mutualunderstandingbybringingpeopleandideastogetherthroughcooperative
argument.
WhiletheCanadianschoolofargumentationstudieshasaphilosophicallineage,
theolderAmericantraditioninargumentationdrawsnourishmentfromthetaprootof
forensics,specificallytheappliedactivityofintercollegiatedebating.59Inthisrespect,
itisnotsurprisingtoseesophisticprinciplessuchasdissoilogoiandsynérchesthé
manifestprominentlyintheworkofcontemporaryAmericanargumentationtheorists
likeDavidZarefskyandCharlesWillard.Consider,forexample,Zarefsky'snotionof
argumentationas"hypothesistesting,"aviewthatseesargumentationasa
"communicationprocessinwhichpeoplemake,attack,anddefendclaimsinorderto
55Isocrates,Nicocles,19,OnthePeace,trans.GeorgeNorlin,LoebClassicalLibrary,vol.2
(London:WilliamHeinemann,1929),2,9.56Isocrates,Panathenaicus,146,Panegyricus,trans.GeorgeNorlin,vol.1,LoebClassicalLibrary
(London:WilliamHeinemann,1928),81.57Isocrates,Panegyricus,43,Helen,trans.LarueVanHook,vol.3,LoebClassicalLibrary
(London:WilliamHeinemann,1945),40,AgainstCallimachus,trans.LarueVanHook,vol.3,LoebClassicalLibrary(London:WilliamHeinemann,1945),45;seealsoTakisPoulakos,SpeakingforthePolis:Isocrates'RhetoricalEducation(Columbia,SC:UniversityofSouthCarolinaPress,1997),19;andHaskins,LogosandPower,8.
58Isocrates,Antidosis,trans.GeorgeNorlin,LoebClassicalLibrary,vol.2(London:WilliamHeinemann,1929).
59FransH.vanEemeren,RobGrootendorst,andFranciscaSnoekHenkemans,etal.,FundamentalsofArgumentationTheory:AHandbookofHistoricalBackgroundsandContemporaryDevelopments(Mahwah,NJ:LawrenceErlbaumAssociates,2006),193‐196.
19
gaintheassentofothersortojustifytheirownbeliefsandacts."60Duringthe1970s
and1980s,theheydayofintercollegiatedebate’s"paradigmwars,”hypothesistesting
haditsshareofadherents,someinthejudgingrankswhoappliedtheparadigmasa
toolforadjudicationofindividualcontestrounds,andothersinthedebatingranks,
whousedtheparadigmtojustifycertainargumentativestrategies(e.g.multiple,
conditionalandcontradictorynegativecounterplans).
LostinthisprocessofreductionwasZarefsky’svisionofacademicdebateasa
vehicletotransportthetheoryandpracticeofargumentationtowidersociety.61
Hypothesistesting,inthiswiderframe,wasaconstructforestablishingthegravitas
andauthorityofforensicsspecialistsinconversationsaboutthenatureof
argumentationbeyondthecontestroundsetting.Here,Zarefsky'sanalogylinking
debatetoscientifichypothesistestingwasnotdesignedtoshowhowdebateitselfwas
ascientificprocess,butrathertoalertexternalaudiencestothefactthatacademic
debate,whiledeviatingsignificantlyfromestablishedpatternsofscientificinquiry,
featuresitsownsetofrigorousproceduresforthetestingofargumentative
hypothesis.Inpublishedscholarshipandinadministrativeleadershiproles,Zarefsky
continuestourgeforensicsspecialiststocontributetheirwealthofexperiencein
designing,executing,andstudyingdebatestoprojectsbeyondthecompetitive
tournamentgridthatrequireexpertiseintheartofdeliberativedesign.T2
translationalmedicinerepresentspreciselysuchanendeavor,askeyleadersinthe
fieldhavecalledformobilizationofmulti‐disciplinaryresearchteamstosurmountthe
60DavidZarefsky,"ArgumentasHypothesis‐testing,"paperpresentedattheSpeech
CommunicationAssociationConvention,December28,1976,SanFrancisco,California.ThekernelofZarefsky'stheoryofhypothesistestingwasoutlinedinanearlierpaper,"AReformulationoftheConceptofPresumption,"presentedattheCentralStatesSpeechAssociationConvention,April7,1972,Chicago,Illinois;seealsoDavidZarefsky,"ArgumentasHypothesis‐testing,"inAdvancedDebate:ReadingsinTheory,PracticeandTeaching,ed.DavidA.Thomas(Skokie,Illinois:NationalTextbookCompany,1979),427‐437.
61DavidZarefsky,"ArgumentationandForensics,"inProceedingsoftheSummerConferenceonArgumentation,ed.J.Rhodes&S.Newell(Annandale,Virginia:SpeechCommunicationAssociation,1980),20‐25;MalcolmO.Sillars&DavidZarefsky,"FutureGoalsandRolesofForensics,"inForensicsasCommunication:TheArgumentativePerspective,ed.J.H.McBath(Skokie,Illinois:NationalTextbookCompany,1975),83‐93;seealsoG.ThomasGoodnight,"TheRe‐unionofArgumentationandDebateTheory,"inDimensionsofArgument:ProceedingsoftheSecondSummerConferenceonArgumentation,ed.GeorgeZiegelmueller(Annandale,Virginia:SpeechCommunicationAssociation),415‐432.
20
scientific,political,andcommunicativechallengesinvolvedintranslatingthefindings
ofbasicscienceintoimprovedcommunityhealthoutcomes.Zarefsky'sinsightthatthe
American,practice‐orientedtraditionofforensicsconstitutesarichstorehouseof
practicalknowledgeregardinginteractionofargument"fields"carriesparticular
relevancehere,sinceakeyaspectoftheT2translationprojectentailsfacilitating
communicationandunderstandingacrossdisparatefieldsofstudy,aswellasbetween
expertandlaycommunities.
TranslationalDeliberation
Itmaybeastretchforthosejadedbydecadesofverbalpyrotechnicscommonly
foundinCrossfire‐stylepoliticaltheatertograspthenotionthatmulti‐sidedargument
canfacilitatemutuallearningacrossepistemologicalchasms.Sincethisistheload‐
bearingpremisesupportingCharlesWillard'snotionof"epistemics,"atthispointit
maybeusefultorevisithisrationaleforconstructiveargumentasabridgingexercise.
Here,itisimportanttostipulatethatWillard'ssenseofargumentstandsincontrastto
thevernacularnotionofargumentasmerequarrelingorverbaljousting(what
Isocratescalled"wordywrangling"andJenicekterms"pimping").62Rather,Willard
viewsargumentationasa"uniquediscourseevent"thatunfoldsinthecontextofa
"socialrelationship"betweentwoormorepeople"sortingoutwhattheyconstrueto
beincompatiblepositions."63Asargumentsdevelop,"theydisplayepistemicstructure
morevividlythannormaldiscourse,fortheybringtothesurfaceassumptionsthat
wouldordinarilyremainsubmerged."Thisisbecause"argumentetiquettepermits
challengesanddemandsforclarificationandsupport,andtheseinturnyieldmore
explicitness."64
62Isocrates,Helen,trans.LarueVanHook,vol.3,LoebClassicalLibrary(London:William
Heinemann,1945),6;Jenicek,Fallacy‐FreeReasoninginMedicine,76‐77.63CharlesArthurWillard,ArgumentationandtheSocialGroundsofKnowledge(Tuscaloosa:
UniversityofAlabamaPress,1983),20‐21.64CharlesArthurWillard,LiberalismandtheProblemofKnowledge:ANewRhetoricfor
ModernDemocracy(Chicago:UniversityofChicagoPress,1996),218.
21
Asastructured"method"65ofinquiry,argumentdrivesconstructive
interchangethroughamechanismthatProtagorasidentifiedascrucialtodissoi
logoi—thatbothsidesofanargumentbetakenintoaccount.Thiselementcontainsa
calltolisten,tostepoutsideone'ssettledperspectiveinanattempttoapprehend
unfamiliarpointsofview.Argumentgenerates"practiceinmakingreflective
judgments"whileit"developsanddisciplinesthecriticalfaculties,"therebydeveloping
agencyinrespecttomakingbetterdecisionsandcommunication"choicesinthe
future."66Onesignificantoutcomeofthisrecursiveprocessisthatthecyclingaspectof
argumentstimulatesinterlocutorstoreflectupon,andinnovateintheirlanguage
usage,"byvirtueoftheirclaimsbeingarticulatedoutsidetheconfinesoftheiroriginal
disciplinarydiscourses."BuildingonWillard'stheory,SteveFullersuggeststhatjoint
enactmentofthisprocessorientsacademicscholarstothechallengeof
interdisciplinarytranslationby"spawning"so‐calledpidginlanguages,"which
reinforcedandextendedovertimecoulddevelopintoaninterdisciplinarylingua
franca."67
Certainly,thistypeofintegrativescientificresearchhasimpressivehistorical
precedents.Forinstance,physicistErwinSchrödingerandbiologistTheodosius
Dobzhanskydeployedinventiverhetoricaldevicesandstrategiestoforgeconceptual
bridgesconnectingmultiplescholarlyaudiences.Dobzhansky'scleveruseof
topographicalmapstovisuallydepictmathematicalpopulationgeneticshelped
biologistsandgeneticistsreachcommonunderstandingsthateventuallyyieldedthe
"modernsynthesis"ofevolutionarybiology.Inasimilarfashion,Schrödingerdeployed
"polysemy,"arhetoricalstrategyofdesigningtextstobereadinmultiplewaysby
65DouglasEhninger,"ArgumentasMethod:ItsNature,itsLimitationsanditsUses,"Speech
Monographs,37(1970):101‐110;seealsoDouglasEhninger&WayneBrockriede,DecisionbyDebate(NewYork:Dodd,Mead&Company,1972);MauriceNatanson,"TheClaimsofImmediacy,"inPhilosophy,RhetoricandArgumenation,ed.MauriceNatansonandHenryW.Johnstone,Jr.(UniversityPark,PA:PennStateUniversityPress,1965),10‐19;andJackW.Meiland,"ArgumentasInquiryandArgumentasPersuasion,"Argumentation,3(1989):185‐196.
66Ehninger,"ArgumentasMethod,"102;seealsoHenryW.Johnstone,Jr.,"SomeReflectionsonArgumentation,"inPhilosophy,RhetoricandArgumenation,1‐9.
67SteveFuller,TheGovernanceofScience(Buckingham:OpenUniversityPress,2000),142;seealsoFuller'sPhilosophy,Rhetoric&theEndofKnowledge:TheComingofScienceandTechnologyStudies(Madison:UniversityofWisconsinPress,1993),44‐48.
22
differentaudiences,toinspirecreativeconversationsbetweenphysicistsand
biologiststhatultimatelygaverisetothehybridfieldofmolecularbiology.68
YetwhererhetoricalcriticLeahCeccarellifindsinthisgenreof"inspirational
interdisciplinarity"arecurrentfeaturethatsuchproseisissuedbyscholarlygiants
withtranscendentpersonas,today'stranslationalmedicinemovementcallsfor
institutionalizationoftranslationalresearchasaroutineformofprofessionalactivity.
Willard'spointthat"differencesamongindividualsanddiscoursesputapremiumon
translation"69highlightshowtheterm"translationalmedicine"herecarriesdouble
meaning.Itsmetaphoricdimensiondescribestheprocessofmovingbasicscience
downtheconveyorbelttoappliedsettings.Butsincethisprocessrequiresintegrative,
cross‐disciplinarycollaboration,theenterprisenecessarilyalsoentailstranslationin
theliteralsense,theinventionofsharedlanguagescapableofbridgingdisparate
epistemiccommunities.ThecontributionsofAmericanargumentationscholarssuchas
WillardandZarefskyindicatethatdeliberativeargumentation("synérchesthé"and
"polloilogoi"intheadaptedsophisticallexicon)haspotentialtoserveasavaluable
translationvehicleforthistask.
DeliberationandArgumentCogency
Theprevioussectionexploredhowcontemporaryformsofpolloilogoican
facilitatetranslationalcommunicationbetweendistinctfieldsofscholarlyinquiry.
Whatabouttranslationacrosstheexpert‐publicboundary?Oneimportantfinding
fromphilosopherWilliamRehg'snewbook,CogentScienceinContext,isthatthese
twotranslationchallengescanbeviewedastwosidesofthesamecoin.Rehg
elucidatesthisconnectionbyreconstructingthenotionofargument"cogency,"
especiallyasitrelatestotheevidentiarydimensionofargumentativepractice.He
beginsbynotingthatcogencyisapromising"boundaryconcept,"byvirtueofthefact
thatithasacommonlyacceptedgeneralmeaning(roughlysynonymouswiththe
68LeachCeccarelli,ShapingSciencewithRhetoric:TheCasesofDobzhansky,Schrödinger,and
Wilson(Chicago:UniversityofChicagoPress,2001).69Willard,LiberalismandtheProblemofKnowledge,309.
23
"strengthorconvincingqualityofarguments"),andalsopossesses"thebreadthand
flexibilitytocoveralargeterritoryofapproachestoargumentevaluation."70Rehgthen
proceedstodevelopatieredmodelofargumentcogencythatexplainshowscientific
argumentsexhibitmeritatthethreelevels:
•Contentmerit:Thedegreetowhichthestructureofanargument
adherestodomain‐specifictopicalandlogicalrequirements(ata
minimumhavingapremiseandaconclusion).
•Transactionalmerit:Thequalityofdialogicexchangebetweenparties
conductinganargument(especiallywhentheargumentspans
disciplinaryboundaries).
•Publicmerit:Theabilityoftheargumenttoappealtoawider
reasonablepublicthatfindsitrelevant,thought‐provoking,or
convincing.71
AppliedtoT2translationalresearch,Rehg'stheoryofcogencycallsattentionto
therelationshipsbetweenanargument'scontent,transactionalandpublicmerits.
Thesenuancesthatareespeciallywellsuitedtoaccountforakeydynamicnotedby
Fuller,thatwhenscientistsfromdifferentfieldsgainopportunitiesforconstructive
inter‐fieldargumentation,
Onceprovidedwithanincentivetointerrogateeachother'sclaims,the
scientiststhemselveswouldbeinapositiontointensifythe
investigation,strippingawaygratuitousjargon,overstatementandall‐
aroundobfuscationthatmightotherwisemystifynon‐experts.Thus,
whatoriginallyappearedtobetheincommensurableknowledge
productsoftwodisciplines—suchasthetheoreticalbenefitsofabranch
ofphysicsandthepracticalbenefitsofabranchofbiology—wouldbe
renderedcomparable...Weredisciplinarycommunitiesmadetobe
routinelyaccountabletoeachother,thenmuchoftheauraofexpertise
70WilliamRehg,CogentScienceinContext:TheScienceWars,ArgumentationTheory,and
Habermas(Cambridge,MA:MITPress,2009),7.71Rehg,CogentScienceinContext,250‐251.
24
andesotericknowledgethatcontinuestokeepthepublicatarespectful
distancefromscientistswouldberemoved.72
Rehg'stheoryofargumentcogencythusprovidesoneavenueformoving
beyondtheunidirectional,siloedmodelfortranslation,whereasingleexpertfield
reachesouttoanaudienceofcitizens/policy‐makers(seeFigure2).
[InsertFigure2abouthere]
Incontrasttothisunidirectionalmodel,theinterdisciplinarytransactionsthat
facilitatetranslationalresearchgeneratelanguagethatnotonlyenablesthesortof
integrativeresearchintheexpertrealm.Such"pidginlanguage,"thankstoits
"fungibility,"haspotentialtobridgeunderstandingbetweenexpertandlayaudiences,
aswell(seeFigure3).73
[InsertFigure3abouthere]
ThecuriouscaseofaspirinhelpsconcretizeRehg'sconceptofhowdeliberation
intranslationalresearchcanpossiblygeneratecogentargumentswithpublicmerit.
Gold‐standarddataestablishthatuseofaspirinbypatientswhohavepreviously
experiencedastrokehelpspreventrecurrentstrokes.74Yetonestudyfindsthatthis
simple,inexpensivetherapyisgivenonlyto58%ofeligiblepatients.75Thisgap
betweenevidenceandpracticereflectsthepresenceofcomplexT2translational
blocksthataccountforwhyahealthcaresystemisunabletorealizesubstantialhealth
caregainswhencompellingscienceclearlyshowsthewayforjustunder5centsa
72Fuller,GovernanceofScience,142.73ThisdynamicbringstomindIsocrates'dictum,"thesameargumentswhichweusein
persuadingotherswhenwespeakinpublic,weemployalsowhenwedeliberateinourownthoughts"(Nicocles,8).
74Aspirincanreducestrokerecurrencebyasmuchas23%:"CollaborativeMeta‐analysisofRandomisedTrialsofAntiplateletTherapyforPreventionofDeath,MyocardialInfarction,andStrokeinHighRiskPatients,"BritishMedicalJournal,324(2002):71‐86.
75E.A.McGlynn,S.M.Asch,andJ.Adams,etal.,"TheQualityofHealthCareDeliveredtoAdultsintheUnitedStates,"NewEnglandJournalofMedicine,348(2003):2635‐2645.
25
day.76AccordingtoStephenWoolfandRobertJohnson,overcomingthesebarriers
requiresmorethanjustpublicationofclinicalguidelinesrecommendingaspirin
prescriptionsforstrokepatients.Rather,WoolfandJohnsonholdthatsurmounting
suchtranslationalblockagesrequiresmacro‐levelapproachestoenhance
communicativecooperationandfacilitateinformationflowsbetweenhealthcare
professionalsandcivicpartners(parallelingthe"allianceformation"functionof
Isocraticsynérchesthé).77
WoolfandJohnson'sanalysispointstothepotentialvalueofdeliberative
argumentasatooltofacilitatetranslationalstrategies.Intheaspirincase,onemight
imagineaninterdisciplinaryresearchteamengaginginstructureddebateoverthe
relativemeritsofcompetingapproachestoovercomeT2translationblocks.Tothe
extentthattheteam'spolloilogoiwouldexhibitwhatRehgcallsstrong"transactional
merit"(interlocutorsarguecooperatively,takerisks,andairsuppressedpremises),the
exercisewouldbeprimedtopercolatecogentargumentswithpublicmerit.According
toRehg'stheory,thesecogentargumentswouldhavepotentialtopersuasivelyframe
strokepreventionthroughaspirintreatmentasapressingandrealisticallyachievable
objectiveforwideaudiences.AsWillardputsit,"eachstageoftranslationfrom
esoterictoexotericrequiresnewsimplificationsandmetaphors."78Notably,this
inventionalchallengediffersinemphasisfromthe"fallacy‐free"programofargument‐
basedmedicineoutlinedbyJenicek,wherethefocusliesonavoidingerrorsin
reasoning,ratherthanproductionofcogentargumentstofacilitateT2translation.79
76TheBritishMedicalJournal's"CollaborativeMeta‐analysis"concludesthatlowdoseaspirin
(75‐150mgdaily)isaneffectiveantiplateletregimenforlong‐termuseinstrokeprevention.InMay2009,Walgreens'websiteadvertisedabottleof125tabletsofregular(325mg)genericbrandaspirintabletsfor$5.99(eachtabletcostingapproximately4.8cents).
77StevenH.WoolfandRobertE.Johnson,"TheBreak‐EvenPoint:WhenMedicalAdvancesareLessImportantthanImprovingtheFidelitywithwhichtheyareDelivered,"AnnalsofFamilyMedicine,3(2005):545‐552.
78Willard,LiberalismandtheProblemofKnowledge,107.79Nevertheless,thisdistinctionshouldnotbeoverdrawn,asitiseasilypossibletoimaginethe
twoapproachesworkinginconcert,justasCanadianandAmericanargumentationscholarscooperatetoelucidatemultipleanglesofargumentativephenomenaatinternationalconferencessuchastheonehostedseriallybytheUniversityofAmsterdam'sInternationalSocietyfortheStudyofArgumentation.
26
DeliberationandPhysician‐Citizenship
WoolfandJohnson'sblueprintforovercomingT2translationblocksasks
physicianstoengageinmodesofpublicadvocacythatdriftquitefarfromthe
traditionalclinicalsetting.Theirlistofpossiblephysician‐drivenpublicargument
campaigns(e.g.pressingforuniversalhealthinsurance,restructureddeliveryand
reimbursementsystems)80mayseemoutofplacetopractitionerstrainedinafield
wherepublicadvocacyskillsreceivelittleornocurricularcoverage.Yetthiscallfor
physician‐drivenpublicadvocacyisechoedbytopleadersinthefield.
TimothyGardner,presidentoftheAmericanHeartAssociation(AHA),recently
gaveamajoraddresstofellowphysicians,healthcareprovidersandcardiovascular
researchers,saying:"Iwantustoacknowledgeoursharedmissionascitizenleaders
andchallengeourselvestoconsidertheimplicationsofthisrallyingcry."81Pushinghis
expertconstituentstobroadentheirprofessionalidentitiestoincludeapolitical
component,Gardnersuggested,"Ascitizenleaders,wemustalsotakeaprominent
publicstanceinsupportofpoliciesthatpromotehealthinourcommunities."82
Gardner'scallforhealthcareprofessionalstoembraceadvocacyrolesas
"citizenleaders"harmonizeswithanearlierstatementbyRussellGruen,Steven
PearsonandTroyenBrennan,whourgedtheirpeersinthemedicalprofessionstoact
ontheirabilitytobe"publicwitnesses"tosocioeconomicdeterminantsofpatients'
healthand"providethesortofinformationandprofessionalauthoritythatbrings
veracityandlegitimacytotheseconcernsinpublicdebate."83Toillustratemodesof
80WoolfandJohnson,"BreakEvenPoint,"550.81TimothyJ.Gardner,"BuildingaHealthierWorld,FreeofCardiovascularDiseasesandStroke:
PresidentialAddressattheAmericanHeartAssociation2008ScientificSessions,"Circulation,119(April7,2009):1838.
82Gardner,"BuildingaHealthierWorld,"1840.AsGardnerexplainsfurther,"Eachofushasourownuniqueandveryimportantroletoplayintheworkofbuildingahealthierworld,bethatasanurse,aresearcher,aclinician,analliedhealthworker,ahealthsystemadministrator,oranadvocateagainstcardiovasculardiseaseandstroke.Butinadditiontoourspecificrole,eachofusisacitizeninourcommunityandsociety.Lettheaccomplishmentstodateoftheantismokingmovementinspireustodomoretoensurethatriskfactorreductionandthepromotionofhealthfulnessareembeddedinourcultureandinourpublicpolicy"("BuildingaHealthierWorld,"1841).
83RussellL.Gruen,StevenD.PearsonandTroyenA.Brennan,“Physician‐Citizens–PublicRolesandProfessionalObligations,”JournaloftheAmericanMedicalAssociation,291(2004):95.
27
politicalengagementopento"physician‐citizens,"Gruen,PearsonandBrennancited
examplessuchas:
•Raisingpublicawarenessaboutahealthorsocialissuebydiscussingit
withfamilyandfriendsorparticipatinginapublicforum.
•Writingaletter,signingapetition,orparticipatinginanotherformof
publicadvocacyandlobbying.
•Encouragingamedicalsocietytoactonanissuethatconcernsthe
public’shealth.
•Organizingandformingagroupforpoliticaladvocacy.84
ItisnotablehowthesesuggestionsreflecttheIsocraticthemeofcollective
actionthroughsynérchesthé.Gruen,PearsonandBrennanemphasizehowtheircall
forpoliticalengagementbyhealthcareprofessionalsisdesignedtotranscend
particularpoliticalideologiesandpromotethecommongoodthroughpublic
deliberation:"Wehaveframedpublicrolesasissuesofevidenceandprofessionalism,
notasmattersofindividualpoliticalpersuasion."85Thisthemeofevidence‐based
politicaladvocacyundertakenbyhealthcareprofessionalsasanexpressionof
citizenshipcanbeseenasanoutgrowthoftheEBMmovementstartedintheearly
1990s.ButwhereasEBMwasdevelopedasanapproachtosharpenphysicians'clinical
decision‐making,thecallsforphysiciancitizenshipandT2translationalresearchdiffer
inkeyrespects.First,thelatterformsofprofessionalactivitynecessarilydemanda
uniquelevelofintegrative,interdisciplinaryexchange(evenmoresothanclinical
practice).Second,sincephysiciancitizenshipandT2translationalresearchentail
84Gruen,PearsonandBrennan,“Physician‐Citizens,"97.85Gruen,PearsonandBrennan,“Physician‐Citizens,"98."Physiciansmustrealizethattheyalso
sharegoalsincommonwithothermembersoftheprofessionandthat,althoughindividualactionislaudable,collectiveactionisahallmarkofprofessionalism.Physiciangroupshavebeenparticularlyeffectiveagentsofchangeininstitutionalissues,localcommunitymatters,legislativeaction,andmuchbroaderissues,suchascivilandhumanrights,preventionofnuclearwar,andthebanningoflandmines.Theselargermovementshaveshownphysicianadvocacytobemosteffectivewhenithasaspecificgoal,aclearmessage,goodsupportingevidence,collectiveaction,andparticipationinthepoliticalprocess"(Gruen,PearsonandBrennan,97)."Physiciansshouldbereassuredthatevensmallactionscanbeinfluential,thatpoliticalinvolvementismorethanjustvotinginelections,andthattheseactivitiesareimportantandadmirableaspectsofcitizenship"(97).
28
publicengagement,theyrequiretranslationnotonlyacrossdisciplinaryboundaries,
butalsoacrossbarriersthatdivideexpertandpubliccommunities.
Conclusion
DilipGaonkar'ssharpattackontherhetoricofscienceresearchprogram
chargesthatscholarssuchasJohnCampbell,LawrencePrelli,andAlanGrosscommita
translationerrorbyutilizingconceptsfromclassicalGreekrhetoricasahermeneutic
metadiscourseforinterpretingscientifictexts.86InGaonkar'stelling,the"hegemonic"
projectto"globalize"rhetoricbybringingalltextualartifacts(evenhardscience)
underitsscopeisanill‐fatedexerciseinsupply‐sideepistemology.Thestakesarehigh,
sinceasGaonkarwarnsnearthecloseofhislandmarkessay,"globalizationseverely
underminesrhetoric'sself‐representationasasituatedpracticalart."87
Gaonkar'sbroadsidehitsclosetohome,asthistooisarhetoricofscienceessay,
onethatleansheavilyontheconceptoftranslation.Yetelementsoftheforegoing
analysisreversethethrustofGaonkar'scritique.Leadingmedicalscholarsshapethe
agendaoftranslationalresearchbyopenlyforegroundingthecommunication
challengesinherentinthekindofintegrative,trans‐disciplinaryresearchnecessaryto
overcomeT2translationalblocks.Theyalsocallforscholarlycontributionsfromthe
fieldofcommunication,notforhelpwiththeinterpretivetaskofcriticizingscientific
texts,butratherforsupportinsynérchesthé,theperformativetaskofcomingtogether
deliberatelyforthepurposeofjointinquiry,collectivechoice‐making,andrenewalof
communicativebonds.
Hereisdemand‐siderhetoricofscience,wherescientificactorsseekenlistment
ofrhetoric'sexpertise.Ratherthanrhetoricpushingitsepistemologyonscience,we
havesciencepullingrhetoricintoitsinterdisciplinaryorbit.The"thinness"ofthe
productivistclassicalGreeklexicon,supposedlyaliabilityinrhetoricalcriticism,here
86DilipParameshwarGaonkar,"TheIdeaofRhetoricintheRhetoricofScience,"inRhetorical
Hermeneutics,ed.AlanG.GrossandWilliamM.Keith(Albany,NY:StateUniversityofNewYorkPress,1997),25‐85.
87Gaonkar,"IdeaofRhetoric,"76.
29
becomesastrengthsupportingthetypeofpractice‐orientedscholarshipthatZarefsky
envisionedgrowingoutofhistheoryofargumentationas"hypothesistesting."
InfairnesstoGaonkar,itshouldbestipulatedthathis1993critiquechallenged
thewayrhetoricofsciencehadbeendonetodate,nottheuniverseofwaysrhetoricof
sciencemightbedoneinthefuture.Andtohispartialcredit(hedidthisinafootnote),
Gaonkardidacknowledgethepromiseofaperformance‐orientedrhetoricofscience,
especiallyoneinformedbyclassicalthinkersotherthanAristotle.88Infact,onewould
expectGaonkartoholdsuchanuancedposition,givenhisintellectualbackground.
MentoredattheUniversityofPittsburghbyfoundingrhetoricianofscienceTrevor
Melia,aswellaslegendaryforensicsdirectorRobertNewman,GaonkarwrotehisPh.D.
dissertationon"AspectsofSophisticPedagogy."89Inthatdot‐matrixtome,Gaonkar
documentshowtheancientsophistswere"thegreatestchampions"of"socially
useful"science,90andalsohowthesophistsessentiallypracticedtheartofrhetoricina
translationalregister:
Thesophistscouldnotblithelygoabouttheirbusinessofmakingscience
useful,whilescienceitselfstoodstillduetolackofcommunalsupport
andrecognition.Besides,sophisticpedagogywasbecomingincreasingly
dependentonthefindingsofcontemporaryspeculationinphilosophy
andscience.Takeforinstance,theeminentlypracticalartofrhetoric.As
taughtbythebestofthesophists,itwasnotsimplyahandbookof
recipeswhichanyonecouldmechanicallyemploytohisadvantage.On
thecontrary,thestrengthandvitalityofsophisticrhetoriccamefrom
theirabilitytoincorporatetherelevantinformationobtainedfromthe
on‐goingresearchinotherfields.91
Ofcoursedeeptrans‐historicaldifferencesmakeuncriticalappropriationof
classicalGreekrhetoricforcontemporaryuseafool'serrand.ButtogaugefromRobert
88Gaonkar,"TheIdeaofRhetoric,"note3,78.89DilipParameshwarGaonkar,"AspectsofSophisticPedagogy,"unpublishedPh.D.diss.,
UniversityofPittsburgh,Pittsburgh,Pennsylvania,1984.90Gaonkar,"AspectsofSophisticPedagogy,"121.91Gaonkar,"AspectsofSophisticPedagogy,"248,emphasisadded.
30
Hariman'srecentreflectionsontheenduringsalienceofIsocrates,"timely,suitable,
andelegantappropriations"canhelpuspost‐moderns"forgeanewpoliticallanguage"
suitableforaddressingthecomplexraftofintertwinedproblemsfacingglobal
society.92Suchretrospectionislongoverdue,saysHariman,as"thehistory,literature,
philosophy,oratory,art,andpoliticalthoughtofGreeceandRomehaveneverbeen
moreaccessibleorlessappreciated."93
Fortunatelytheprojectofre‐connectingwithourfield'ssophisticrootsis
leveragedimmeasurablybythepresenceofafewsophosinourmidstwhose
intellectuallineagecanbetraced,albeitcircuitously,totheoriginalsophists—
ProtagorasandIsocrates.Theinter‐generationalconnector,inthiscase,isforensics—
thepracticalenterpriseofcooperativelycompetitivespeech‐making.Onefindsearly
instantiationsofforensicsinProtagoras'pedagogicalmethodofdissoilogoi,aswellas
precursorstowhatwenowthinkofaspublicdebateinIsocraticlogospolitikos.Inthe
early20thcentury,luminariessuchasWaylandMaxfieldParrish,FrankHardyLane,
andevenHerbertWichelns(himselfadebatecoachattheUniversityofPittsburgh),re‐
animatedthesophistictraditionbydevelopingnewformsofpublicdebateandpublic
speaking,activitiesthatservedasafulcrumthatthenascentfieldofcommunication
wouldusetosplitofffromEnglish.DavidZarefskydescendsfromthatsamelineof
intellectualforebears.Thebestofthesophisticaltraditionisevidentinhis
performancesasachampiondebaterandcoach,hisprofessionalleadershipofan
academicfield,andhisscholarlywritingsonargumentationtheoryandpractice.
92RobertHariman,"CivicEducation,ClassicalImitation,andDemocraticPolity,"inIsocrates
andCivicEducation,228.93Hariman,"CivicEducation,"217.
31
Appendix:TablesandFigures
Table1.ResultsofaNLMsearchforarticlesfocusingonEvidence‐BasedMedicineinselectedyearsbetween1990and2008*
Year of Publication
Number of Articles
1990 0 1992 2 1994 12 1996 245 1998 1095 2000 1957 2002 2809 2004 3383 2006 4177 2008 4744
* search performed 5/24/2009
32
Figure1.Evidence‐BasedMedicineHierarchyofEvidenceTypes.Permissionpending.
33
Figure2.Unidirectionalmodelfortranslationofevidencefromsiloedexpertfieldstowiderpublicsandpolicymakers.
34
Figure3.Translationthroughpolloilogoi.Argumentationbetweenexpertscholarlyfieldsgeneratesbridginglanguagethatsupportscogentevidence.Thisfacilitatesintegrativeresearchandsupportstranslationeffortsdesignedtocommunicatefindingstowiderpublicsandpolicy‐makers(adaptedfromRehg,CogentScienceinContext).