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  • 1.
    Howick, Jeremy
    et al.
    University of Oxford.
    Ashley, Graham Kennedy
    Florida Atlantic University.
    Mebius, Alexander
    Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.
    Philosophy of Evidence-Based Medicine2015In: Oxford Bibliographies in Philosophy / [ed] Duncan Pritchard, Oxford University Press, 2015Chapter in book (Refereed)
    Abstract [en]

    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 EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM.

  • 2.
    Howick, Jeremy
    et al.
    University of Oxford.
    Fanshawe, Thomas R
    University of Oxford.
    Mebius, Alexander
    KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy. Ludwig Maximilian University Munich.
    Heneghan, Carl J
    University of Oxford.
    Bishop, Felicity
    University of Southampton.
    Little, Paul
    University of Southampton.
    Mistiaen, Patriek
    Belgian Health Care Knowledge Centre (KCE).
    Roberts, Nia W
    University of Oxford.
    Effects of changing practitioner empathy and patient expectations in healthcare consultations2015In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493XArticle in journal (Refereed)
  • 3.
    Howick, Jeremy
    et al.
    University of Oxford.
    Mebius, Alexander
    Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy. University of Oxford, UK.
    Randomized trials and observational studies: the current philosophical controversy2016In: Handbook of the Philosophy of Medicine / [ed] Schramme, Thomas and Steven Edwards, Springer, 2016, p. 873-886Chapter in book (Refereed)
    Abstract [en]

    The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.

  • 4.
    Howick, Jeremy
    et al.
    University of Oxford.
    Thomas R, Fanshawe
    University of Oxford.
    Mebius, Alexander
    University of Oxford, United Kingdom.
    Bishop, Felicity
    University of Southampton.
    van Osch, Mara
    NIVEL (Netherlands Institute for Health Services Research).
    van Dulmen, Sandra
    Radboud University Medical Center.
    Christelis, Nick
    Monash University.
    Kaptchuk, Ted
    Harvard Medical School.
    Lewith, George
    Monash University.
    Mistiaen, Patriek
    Belgian Health Care Knowledge Centre (KCE).
    Positive "framing" as a powerful medication for pain: A meta-analysis of randomized trials2016In: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 8, p. 57-59Article in journal (Refereed)
    Abstract [en]

    Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate of the effect size of positive framing for treating pain. Such an estimate is useful to understand the extent to which positive expectations can enhance usual care.

    Methods: We extracted data from a recent systematic review of interventions that modified all "context factors" (including but not limited to) inducing positive expectations) in adults suffering from pain. The systematic review concluded that positive expectations were effective, but did not pool the results so no effect size was provided. Two authors independently extracted data from the studies and conducted the analysis. Our primary outcome was patient self-reported pain.

    Results: 10 randomized trials were eligible for meta-analysis. In the trials with continuous outcomes the standardized effect size was −0.39 (95% confidence interval −0.68 to −0.10, p = 0.009, I2 = 79%), suggesting reduced pain on average in groups in which positive expectations were induced. The effect size was similar in magnitude but was not statistically significant when we excluded studies deemed to have a high risk of bias (standard effect size −0.31, 95% CI −0.65 to 0.02, p = 0.07, I2 = 77%).

    Conclusion: The effect of inducing positive expectations is comparable to the effects of some pharmacological drugs. However many of the studies had a high risk of bias, and heterogeneity was significant. Future research is warranted including investigating ways to implement this evidence into patient care in an ethical way.

  • 5.
    Mebius, Alexander
    et al.
    Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.
    Graham Kennedy, Ashley
    Florida Atlantic University.
    Howick, Jeremy
    University of Oxford, UK.
    Research gaps in the philosophy of evidence-based medicine2016In: Philosophy Compass, ISSN 1747-9991, E-ISSN 1747-9991, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine (EBM). 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 (a) the nature of clinical reasoning and the question of whether it can be standardized; (b) the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; (c) evidence synthesis (systematic reviews and meta-analyses); and (d) the nature and ethics of placebo controls. Philosophical analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice. 

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