Mapping uncertainty in precision medicine: A systematic scoping review.

RATIONALE: Although precision medicine is seen by many as one of the most promising advances in the field of medicine, it has also raised critical questions at various levels. Many of these concerns revolve around an observation described by Kimmelman and Tannock as the 'paradox of precision medicine': somewhat surprisingly, uncertainty seems to be a key characteristic of precision medicine in practice. AIMS AND OBJECTIVE: To better understand this concept and the underlying issues, a scoping review was undertaken to search for factors stated in the literature as contributing to or being aspects of uncertainty in precision medicine. METHODS: A systematic search of the literature was conducted in three databases (Pubmed, Web of Science, and Jstor) and complemented with a systematic hand-search. The initial search provided 1.252 items of which 51 articles for selected as eligible for further analysis. These articles were coded with MAXQDA and categorized into four main themes (a-d) of uncertainty. The main results were summarized and discussed with a view to the interrelations between different aspects and implications for precision medicine in practice. RESULTS: The mapping of different aspects and sources of uncertainty leads to the key result that 'uncertainty' should be understood as a cluster concept. Uncertainties are identified in many different respects and situated at different levels: Most complexity-related issues (theme a) can best be understood as ontological ('world-sided') aspects of the uncertainty paradox. Conceptual (theme b) and evidence-related uncertainties (theme c) are situated on an epistemological or methodological level, addressing foundational and normative challenges related to knowledge production in precision medicine. Finally, theme (d) targets issues on the level of material precision medicine practices. These levels are helpful to understand the different dimensions of the uncertainty paradox. CONCLUSIONS: Uncertainty may not merely be a transient effect of the novelty of the precision medicine paradigm. Rather, it should be seen as a consequence of the ontological, epistemological and practical complexity of precision medicine, implying that uncertainty will not necessarily be reduced by more research. This finding encourages further investigations to better understand the interactions among various factors and aspects of uncertainty in precision medicine and the resulting implications for research and medical practice.

Pandemics, policy, and pluralism: A Feyerabend-inspired perspective on COVID-19.

We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend's philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend's arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into policy advice thus contributing to discussions about normative issues concerning evidence and expertise in policy-making.

Follow *the* science? On the marginal role of the social sciences in the COVID-19 pandemic.

In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis.

Scientific inertia in animal-based research in biomedicine.

Despite aspirations to substitute animal experimentation with alternative methods and recent progress in the area of non-animal approaches, such as organoïds and organ(s)-on-a-chip technologies, there is no extensive replacement of animal-based research in biomedicine. In this paper, I will analyse this state of affairs with reference to key institutional and socio-epistemic barriers for the development and use of non-animal approaches in the context of biomedical research in Europe. I will argue that there exist several factors that inhibit change in this context. In particular, there is what I call "scientific inertia", i.e. a certain degree of conservatism in scientific practice regarding the development and use of non-animal approaches to replace animal experimentation. This type of inertia is facilitated by socio-epistemic characteristics of animal-based research in the life sciences and is a key factor in understanding the status quo in biomedical research. The underlying reasons for scientific inertia have not received sufficient attention in the literature to date because the phenomenon transcends traditional disciplinary boundaries in the study of animal experimentation. This paper addresses this issue and seeks to contribute to a better understanding of scientific inertia by using a methodology that looks at the interplay of institutional, epistemic, and regulatory aspects of animal-based research.

The COVID-19 pandemic: a case for epistemic pluralism in public health policy.

This paper uses the example of the COVID-19 pandemic to analyse the danger associated with insufficient epistemic pluralism in evidence-based public health policy. Drawing on certain elements in Paul Feyerabend's political philosophy of science, it discusses reasons for implementing more pluralism as well as challenges to be tackled on the way forward.