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Corroborating evidence-based medicine
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.ORCID iD: 0000-0001-9730-2133
2014 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 6, 915-920 p.Article in journal (Refereed) Published
Abstract [en]

Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014. Vol. 20, no 6, 915-920 p.
Keyword [en]
corroboration, evidence-based medicine, mechanisms, meta-analysis, quality of evidence, randomized control trials
National Category
Public Health, Global Health, Social Medicine and Epidemiology Philosophy
Research subject
Philosophy
Identifiers
URN: urn:nbn:se:kth:diva-161233DOI: 10.1111/jep.12129ISI: 000350450200027PubMedID: 24738869Scopus ID: 2-s2.0-84923012451OAI: oai:DiVA.org:kth-161233DiVA: diva2:794284
Note

QC 20150311

Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Philosophical controversies in the evaluation of medical treatments: With a focus on the evidential roles of randomization and mechanisms in Evidence-Based Medicine
Open this publication in new window or tab >>Philosophical controversies in the evaluation of medical treatments: With a focus on the evidential roles of randomization and mechanisms in Evidence-Based Medicine
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2015. 20 p.
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831
Keyword
Evidence, randomized controlled trials, observational studies, systematic reviews, meta-analysis, methodology, process assessment, outcome assessment, medical care, randomization, evidence-based medicine, selection bias, philosophy of medicine, philosophy of science, mechanisms, quality of evidence, animal studies, treatment effect, causation by absence, medical technology
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Philosophy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-161489 (URN)978-91-7595-489-9 (ISBN)
Public defence
2015-03-27, Kollegiesalen, Brinellvägen 8, KTH, Stockholm, 13:00 (English)
Opponent
Supervisors
Note

QC 20150312

Available from: 2015-03-12 Created: 2015-03-11 Last updated: 2015-03-12Bibliographically approved

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Mebius, Alexander

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