Theoretical Medicine and Bioethics 34 (4):275-291 (2013)

Jeremy Howick
Oxford University
Proponents of evidence-based medicine and some philosophers of science seem to agree that knowledge of mechanisms can help solve the problem of applying results of controlled studies to target populations (‘the problem of extrapolation’). We describe the problem of extrapolation, characterize mechanisms, and outline how mechanistic knowledge might be used to solve the problem. Our main thesis is that there are four often overlooked problems with using mechanistic knowledge to solve the problem of extrapolation. First, our understanding of mechanisms is often (and arguably, likely to remain) incomplete. Secondly, knowledge of mechanisms is not always applicable outside the tightly controlled laboratory conditions in which it is gained. Thirdly, mechanisms can behave paradoxically. Fourthly, as Daniel Steel points out, using mechanistic knowledge faces the problem of the ‘extrapolator’s circle’. At the same time, when the problems with mechanistic knowledge have been addressed, such knowledge can and should be used to mitigate (nothing can entirely solve) the problem of extrapolation
Keywords Randomized trials  Evidence-based medicine  Mechanism  External validity  Implementation  Extrapolation  Nancy Cartwright
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DOI 10.1007/s11017-013-9266-0
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References found in this work BETA

Thinking About Mechanisms.Peter 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.
The Philosophy of Evidence-Based Medicine.Jeremy Howick - 2011 - Wiley-Blackwell, Bmj Books.
Explanation: A Mechanist Alternative.William Bechtel & Adele Abrahamsen - 2005 - Studies in History and Philosophy of Biological and Biomedical Sciences 36 (2):421-441.

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Citations of this work BETA

Establishing Causal Claims in Medicine.Jon Williamson - 2019 - International Studies in the Philosophy of Science 32 (1):33-61.
The ‘Big Picture’: The Problem of Extrapolation in Basic Research.Tudor M. Baetu - 2016 - British Journal for the Philosophy of Science 67 (4):941-964.

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