The Philosophy of Evidence-based Medicine. A philosophical analysis of the evidence 2019-01-10

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Philosophy of Medicine (Stanford Encyclopedia of Philosophy)

The Philosophy of Evidence-based Medicine

The confusion is a good indication that some conceptual clarification is in order, and that is our principal aim in this paper. The questions raised by this debate are fundamental: How should physicians practice medicine? Mismeasurement and diagnostic error provide another account of spurious correlation. Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women: The Women's Health Initiative Memory Study: A Randomized Controlled Trial. From the Quinean perspective, we could also say that all three are anchored to observation statements at the periphery of the web in similar ways. But because such claims are connected to so many other beliefs, their rejection would typically require revision to many, many sentences within the web.

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The Philosophy of Evidence‐Based Medicine

The Philosophy of Evidence-based Medicine

The development of this social process depends on the settings, context, and the values and expectations of the participants. Introduction: How Should We Define Health and Disease? And therefore, if C causes E in a model species or population and C has the causal capacity to bring about E, then there is some reason to believe that C causes E also in the target species or population for a defense, see Cartwright 2011. It can also be used to measure the effectiveness of interventions, though these are usually health policy rather than medical interventions narrowly construed. A maximum estimated likelihood approach is proposed for estimation of the parameters. Under such a definition, medicine should not engage in aesthetic surgery or elective terminations of pregnancy or similar procedures which do not strictly speaking seek to restore health. Hybrid theories of health and disease attempt to overcome the gaps in both the naturalistic and normative approaches, by hybridizing aspects of both theories Reznek 1987; Wakefield 1992; Caplan 1992. Since peers play a critical role in the psychosocial development of most adolescents, peer education is currently considered as a health promotion strategy in adolescents.


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(PDF) The Philosophy of Evidence

The Philosophy of Evidence-based Medicine

Examples include those organs or structures that no longer have a function due to evolutionary processes cannot malfunction and so cannot be diseased. It has been argued that there is no philosophically or scientifically compelling distinction between diseases and other types of complaints that many would not consider to be diseases such as small stature, obesity, or migraine headaches Reznek 1987. If, for instance, the symptoms of a patient or group of patients improve after an intervention, this may be due to spontaneous remission rather than the treatment. It is a useful concept as it allows a clear focus on problems that afflict particular human beings and suggests that medicine can help to control or ameliorate such problems. A further issue often noted with regard to naturalistic accounts of disease for example, that of Lennox 1995 is the underlying assumption that biological fitness survival and reproduction is the goal of human life, and along with this that medicine is only considered to be interested in biological fitness, rather than other human goals and values, some of which might indeed run contrary to or make no difference in terms of the goal of biological fitness, such as relief of pain.

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The philosophy of evidence

The Philosophy of Evidence-based Medicine

But so would a variety of other hypotheses. But it is also clear that randomization is at best sufficient but not necessary to achieve the result. Medical explanation, thus, is closely related to our instrumental interests in controlling, preventing and controlling outcomes Whitbeck 1977. Everyone, it seems, is on the bandwagon, from medical societies and pharmaceutical companies to general practitioners and surgeons, in the quest for an evidence-based practice. A classic case of this is the accidental discovery of penicillin by Alexander Fleming, though Fleming himself initially paid little attention to the possible therapeutic uses of the mold.

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Philosophy of Evidence

The Philosophy of Evidence-based Medicine

Mismeasurement could therefore also be ruled out. This paper analyses whether this is the case. Some would advocate that this process is no different than usual methods in philosophy of science for hypothesis generation and testing based on evidence, and this type of model fits with what is termed differential diagnosis. Kelly Smith 1992 disputes this, noting that the second condition depends on an extremely problematic distinction between causes in this case genes and mere conditions e. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The first design utilizes information from baseline predictors of the immune response, and bridges their relationship in the vaccine recipients to the placebo recipients.

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(PDF) The Philosophy of Evidence

The Philosophy of Evidence-based Medicine

The sickle cell trait is 50% protective against mild clinical malaria, 75% protective against admission to the hospital for malaria, and almost 90% protective against severe or complicated malaria Williams et al. Physicians can also understand and benefit from observations made centuries ago e. The Philosophy of Evidence Based Medicine 2011 by helps answer the question of how to think about medicine so that judgement can be made. Better numeracy and statistical training at universities can help to eliminate some cognitive biases Gigerenzer 2014. But recall that an observation sentence is one that would elicit assent from any competent observer. Thus the dividing line between disease and health is notoriously vague, due in part to the wide range of variations present in the human population and to debates over whether many concepts of disease are socially constructed. A placebo is an intervention that resembles the new treatment in all respects except that it has no known ingredients active for the condition under investigation i.

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(PDF) The Philosophy of Evidence

The Philosophy of Evidence-based Medicine

The innovation of educational interventions was based on three cornerstones, ie. Quine describes the totality of our beliefs — from ordinary common sense claims to the laws of physics — as a web, and he thus speaks of the web of belief. Well-written and as approachable as any work in the philosophy of science might hope to be. Centre for Evidence-Based Medicine; 2003. Moreover, if the man who has the accident now can be expected to live with the disease for 30 years, future years of disability are discounted by a factor. According to the analogy, the web of belief comprises statements; certain of the statements are closer to the periphery or frame, which consists of our sensory experience.

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On evidence and evidence

The Philosophy of Evidence-based Medicine

Answers to these questions will fit somewhere in the web of belief. Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case. A number of philosophers of medicine have in the past decade or so argued that these stronger claims do not hold to scrutiny. The observation sentences are those that are more likely to be denied or affirmed on the basis of immediate sensory experience. There are numerous reasons for aiming to quantify medical outcomes.

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Philosophy of Medicine (Stanford Encyclopedia of Philosophy)

The Philosophy of Evidence-based Medicine

How should health care dollars best be spent? Suppose tuberculosis was on the rise a generation or so after many people traded pipe smoking for cigarette smoking. Although ethics and values are part of many problems addressed within the philosophy of medicine, bioethics is generally considered to be a distinct field, and hence is not explored in this entry but see the entry on. J R Coll Physicians Lond. These kinds of worries can be raised with respect to each of the measurement tests. A comparison of observational studies and randomized, controlled trials. If we do not have any idea what sort of dividing line there might be, then it is not clear that talk of paradigms comes to anything at all. More recently it has been argued that although explanatory reduction cannot be defended on metaphysical grounds, reductive explanations might be indispensable ways to address certain questions in the most accurate, adequate, and efficient ways van Bouwel et al.


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(PDF) The philosophy of Evidence

The Philosophy of Evidence-based Medicine

Every scientist, at some point in his career, learns that one cannot judge X to be a cause of Y just because X and Y are correlated. The advocate of double-blind trials contends, in effect, that simple statements about the patients' condition are not observation sentences after all, for the sentence might not elicit assent from all competent observers — especially for 'soft' end points such as pain scales. Blindness, say, has a greater impact on the burden of disease if it occurs at age 20 than if it occurs at very young or older ages Prüss-Üstün et al. While there has been considerable debate about these questions, it seems to us that the debate also involves some confusion. To what extent this method will be successful therefore similarly case-dependent as comparative process tracing.

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