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Jeremy Howick
Oxford University
  1. The Philosophy of Evidence-Based Medicine.Jeremy Howick - 2011 - Wiley-Blackwell, Bmj Books.
    The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness -- Questioning (...)
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  2. Exposing the Vanities—and a Qualified Defense—of Mechanistic Reasoning in Health Care Decision Making.Jeremy Howick - 2011 - Philosophy of Science 78 (5):926-940.
    Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Yet evidence about mechanisms does not feature on dominant evidence-based medicine “hierarchies.” After arguing that only inferences from mechanisms (“mechanistic reasoning”)—not mechanisms themselves—count as evidence, I argue for a middle ground. Mechanistic reasoning is not required to establish causation when we have high-quality controlled studies; moreover, mechanistic reasoning is more problematic than has been assumed. Yet where the problems can (...)
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  3. How Evidence-Based Medicine is Failing Due to Biased Trials and Selective Publication.Susanna Every-Palmer & Jeremy Howick - 2014 - Journal of Evaluation in Clinical Practice 20 (6):908-914.
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    Questioning the Methodologic Superiority of 'Placebo' Over 'Active' Controlled Trials.Jeremy Howick - 2009 - American Journal of Bioethics 9 (9):34-48.
    A resilient issue in research ethics is whether and when a placebo-controlled trial is justified if it deprives research subjects of a recognized treatment. The clinicians' moral duty to provide the best available care seems to require the use of ‘active’ controlled trials that use an established treatment as a control whenever such a therapy is available. In another regard, ACTs are supposedly methodologically inferior to PCTs. Hence, the moral duty of the clinical researcher to use the best methods will (...)
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  5.  45
    The Importance of Values in Evidence-Based Medicine.Michael P. Kelly, Iona Heath, Jeremy Howick & Trisha Greenhalgh - 2015 - BMC Medical Ethics 16 (1):69.
    Evidence-based medicine has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.
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    Positive Messages May Reduce Patient Pain: A Meta-Analysis.Jeremy Howick & Alexander Mebius - 2017 - European Journal of Integrative Medicine 11:31-38.
    Introduction Current treatments for pain have limited benefits and worrying side effects. Some studies suggest that pain is reduced when clinicians deliver positive messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction. -/- Methods We included randomized trials of the effects of positive messages in a subset of the studies included in a recent systematic review of context factors for treating pain. (...)
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    The Relativity of ‘Placebos’: Defending a Modified Version of Grünbaum’s Definition.Jeremy Howick - 2017 - Synthese 194 (4):1363-1396.
    Debates about the ethics and effects of placebos and whether ‘placebos’ in clinical trials of complex treatments such as acupuncture are adequate rage. Yet there is currently no widely accepted definition of the ‘placebo’. A definition of the placebo is likely to inform these controversies. Grünbaum’s characterization of placebos and placebo effects has been touted by some authors as the best attempt thus far, but has not won widespread acceptance largely because Grünbaum failed to specify what he means by a (...)
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  8. Problems with Using Mechanisms to Solve the Problem of Extrapolation.Jeremy Howick, Paul Glasziou & Jeffrey K. Aronson - 2013 - Theoretical Medicine and Bioethics 34 (4):275-291.
    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 (...)
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  9. Philosophy of Evidence Based Medicine (Oxford Bibliography: Http://Www.Oxfordbibliographies.Com/View/Document/Obo-9780195396577/Obo-9780195396577-0253.Xml).Jeremy Howick, Ashley Graham Kennedy & Alexander Mebius - 2015 - Oxford Bibliography.
    Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between (...)
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    Research Gaps in the Philosophy of Evidence‐Based Medicine.Alexander Mebius, Ashley Graham Kennedy & Jeremy Howick - 2016 - Philosophy Compass 11 (11):757-771.
    Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine. Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including the nature of clinical reasoning and the question of whether it can be standardized; the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; evidence synthesis ; and the nature and ethics of placebo controls. Philosophical (...)
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  11.  20
    Saying Things the “Right” Way: Avoiding “Nocebo” Effects and Providing Full Informed Consent.Jeremy Howick - 2012 - American Journal of Bioethics 12 (3):33-34.
    The American Journal of Bioethics, Volume 12, Issue 3, Page 33-34, March 2012.
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  12.  9
    Philosophy of Too Much Medicine Conference Report.Susanne Uusitalo & Jeremy Howick - 2018 - Journal of Evaluation in Clinical Practice 24 (5):1011-1012.
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  13. Placebo Use in the United Kingdom: Results From a National Survey of Primary Care Practitioners.Jeremy Howick - 2013 - PLoS 8 (3).
    Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected (...)
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  14.  17
    Problematic Placebos in Physical Therapy Trials.Matthew Maddocks, Roger Kerry, Andrew Turner & Jeremy Howick - 2016 - Journal of Evaluation in Clinical Practice 22 (4):598-602.
    The function of a placebo control in a randomised trial is to permit blinding and reduce risk of bias. Adopting Grűnbaum’s definitional scheme of a placebo, all treatments must be viewed as packages consisting of characteristic and incidental features. An adequate placebo for an experimental treatment contains none of the characteristic features, all of the incidental features, and nothing more. For drug treatments, characteristic features can be readily identified, isolated, and separated. By contrast, physical therapy treatments often involve features such (...)
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  15.  6
    Stats.Con.Jeremy Howick - 2011 - Journal of Evaluation in Clinical Practice 17 (5):1011-1012.
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    Reviewing the Unsubstantiated Claims for the Methodological Superiority of 'Placebo' Over 'Active' Controlled Trials: Reply to Open Peer Commentaries.Jeremy Howick - 2009 - American Journal of Bioethics 9 (9):5-7.
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  17. If Children Understand Drawing Straws and Flipping Coins, Research Participants Can Understand Randomization.Jeremy Howick - 2009 - American Journal of Bioethics 9 (2):19 – 20.
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  18.  66
    Against a Priori Judgements of Bad Methodology: Questioning Double-Blinding as a Universal Methodological Virtue of Clinical Trials.Jeremy Howick - unknown
    The feature of being ‘double blind’, where neither patients nor physicians are aware of who receives the experimental treatment, is universally trumpeted as being a virtue of clinical trials. The rationale for this view is unobjectionable: double blinding rules out the potential confounding influences of patient and physician beliefs. Nonetheless, viewing successfully double blind trials as necessarily superior leads to the paradox that very effective experimental treatments will not be supportable by best (double-blind) evidence. It seems strange that an account (...)
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  19.  1
    Exploring the Asymmetrical Relationship Between the Power of Finance Bias and Evidence.Jeremy Howick - 2019 - Perspectives in Biology and Medicine 62 (1):159-187.
    Power determines what counts as knowledge, what kind of interpretation attains authority as the dominant interpretation. Power procures the knowledge which supports its purposes, while it ignores or suppresses that knowledge which does not serve it.In many important cases, sociological forces, mostly financial conflicts of interest are powerful enough to upstage evidence when it comes to deciding whether interventions are safe and effective. Using three widely cited historical cases that are hailed as successes of evidence vis-à-vis finance bias, I show (...)
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    Empirical Evidence Against Placebo Controls.Sadhvi Batra & Jeremy Howick - 2017 - Journal of Medical Ethics 43 (10):707-713.
    The revised Declaration of Helsinki allows placebo-controlled trials to be used even when there is an established therapy, provided there are adequate ‘methodological’ reasons for doing so. This seems to violate the principle of beneficence: where there is an established therapy, physicians treating patients with a placebo are withholding a known effective therapy. Because of this problem, we hypothesised that clinical researchers may be unwilling to risk violating the principle of beneficence and employ placebo-controlled trials in cases where there is (...)
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