Mechanisms: what are they evidence for in evidence-based medicine?


Authors
Holly Andersen
Simon Fraser University
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
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Reprint years 2012
DOI 10.1111/j.1365-2753.2012.01906.x
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References found in this work BETA

Thinking About Mechanisms.Peter K. Machamer, Lindley Darden & Carl F. Craver - 2000 - Philosophy of Science 67 (1):1-25.
Explanation: A Mechanist Alternative.William Bechtel - 2005 - Studies in History and Philosophy of Biol and Biomed Sci 36 (2):421--441.

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Citations of this work BETA

Corroborating Evidence-Based Medicine.Alexander Mebius - 2014 - Journal of Evaluation in Clinical Practice 20 (6):915-920.
The Risk GP Model: The Standard Model of Prediction in Medicine.Jonathan Fuller & Luis J. Flores - 2015 - Studies in History and Philosophy of Science Part C 54:49-61.
Physiological Mechanisms and Epidemiological Research.Robyn Bluhm - 2013 - Journal of Evaluation in Clinical Practice 19 (3):422 - 426.

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