Mechanisms: what are they evidence for in evidence-based medicine?
Journal of Evaluation in Clinical Practice 18 (5):992-999 (2012)
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.Author's Profile
DOI
10.1111/j.1365-2753.2012.01906.x
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Citations of this work
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: Studies in History and Philosophy of Biological and Biomedical Sciences 54:49-61.
Mechanistic Explanation in Systems Biology: Cellular Networks.Dana Matthiessen - 2017 - British Journal for the Philosophy of Science 68 (1):1-25.
Reason and value: making reasoning fit for practice.Michael Loughlin, Robyn Bluhm, Stephen Buetow, Ross E. G. Upshur, Maya J. Goldenberg, Kirstin Borgerson, Vikki Entwistle & Elselijn Kingma - 2012 - Journal of Evaluation in Clinical Practice 18 (5):929-937.
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: Studies in History and Philosophy of Biological and Biomedical Sciences 54:49-61.
References found in this work
Making Things Happen: A Theory of Causal Explanation.James Woodward - 2003 - Oxford University Press.
Scientific Explanation and the Causal Structure of the World.Wesley C. Salmon - 1984 - Princeton University Press.
Explaining the Brain: Mechanisms and the Mosaic Unity of Neuroscience.Carl F. Craver - 2007 - Oxford University Press, Clarendon Press.
Thinking about mechanisms.Peter Machamer, Lindley Darden & Carl F. Craver - 2000 - Philosophy of Science 67 (1):1-25.