Mechanisms: what are they evidence for in evidence-based medicine
Journal of Evaluation in Clinical Practice (forthcoming)
| Abstract | Even though the evidence‐based medicine movement (EBM) labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population‐level recommendations to individual patients. Thus, even though the evidence‐based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of evidencebased medicine who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms. | |||||||||
| Keywords | mechanisms reasoning evidence complexity medicine | |||||||||
| Categories | ||||||||||
| Options |
|
|||||||||
Download options| PhilPapers Archive |
Upload a copy of this paper Check publisher's policy on self-archival Papers currently archived: 5,679 |
| External links | This entry has no external links. Add one. |
| Through your library | Configure |
Similar books and articlesJeremy Howick (2011). The Philosophy of Evidence-Based Medicine. Wiley-Blackwell, Bmj Books.
Brian Hazelton Walsh (2010). The Spatialisation of Disease: Foucualt and Evidence-Based Medicine (Ebm). Journal of Bioethical Inquiry 7 (1):31-42.
Adam la Caze (2011). The Role of Basic Science in Evidence-Based Medicine. Biology and Philosophy 26 (1):81-98.
Maya J. Goldenberg (2012). Innovating Medical Knowledge: Undestanding Evidence-Based Medicine as a Socio-Medical Phenomenon. In Nikolaos Sitaras (ed.), Evidence-Based Medicine: Closer to Patients or Scientists? InTech Open Science.
Hillel D. Braude (2009). Clinical Intuition Versus Statistics: Different Modes of Tacit Knowledge in Clinical Epidemiology and Evidence-Based Medicine. Theoretical Medicine and Bioethics 30 (3):181-198.
Malcolm Parker (2002). Whither Our Art? Clinical Wisdom and Evidence-Based Medicine. Medicine, Health Care and Philosophy 5 (3):273-280.
R. E. G. Upshur & Errol Colak (2003). Argumentation and Evidence. Theoretical Medicine and Bioethics 24 (4).
Maya J. Goldenberg (2009). Iconoclast or Creed? Objectivism, Pragmatism, and the Hierarchy of Evidence. Perspectives in Biology and Medicine 52 (2):168-187.
A. la Caze (2009). Evidence-Based Medicine Must Be .. Journal of Medicine and Philosophy 34 (5):509-527.
Mona Gupta (2007). Does Evidence-Based Medicine Apply to Psychiatry? Theoretical Medicine and Bioethics 28 (2):103.
Maya J. Goldenberg (2006). On Evidence and Evidence-Based Medicine: Lessons From the Philosophy of Science. Social Science and Medicine 62 (11):2621-2632.
Wendy Lipworth, Stacy M. Carter & Ian Kerridge (2008). The “Ebm Movement”: Where Did It Come From, Where is It Going, and Why Does It Matter? Social Epistemology 22 (4):425 – 431.
Ian Kerridge, Stacy M. Carter & Wendy Lipworth (2008). The “EBM Movement”: Where Did It Come From, Where is It Going, and Why Does It Matter? Social Epistemology 22 (4):425-431.
Adam La Caze (2008). Evidence-Based Medicine Can't Be…. Social Epistemology 22 (4):353 – 370.
Analytics
Monthly downloads
Sorry, there are not enough data points to plot this chart.
|
Added to index2012-07-19Total downloads0Recent downloads (6 months)0How can I increase my downloads? |
My notes
Discussion
