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Hunting side effects and explaining them: should we reverse evidence hierarchies upside down? Topoi

Osimani, Barbara (2014) Hunting side effects and explaining them: should we reverse evidence hierarchies upside down? Topoi. Topoi, 33. pp. 295-312.

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Abstract

Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special attention to the privileged role assigned to randomized controlled trials (RCTs) in evidence based medicine. Regardless of whether the RCT’s privilege holds for efficacy assessment, it is nevertheless important to make a distinction between causal inference of intended and unintended effects, in that the unknowns at stake are heterogonous in the two contexts. However, although “lower level” evidence is increasingly acknowledged to be a valid source of information contributory to assessing the risk profile of medications on theoretical or empirical grounds, current practices have difficulty in assigning a precise epistemic status to this kind of evidence because they are more or less implicitly parasitic on the (statistical) methods developed to test drug efficacy. My thesis is that (1) “lower level” evidence is justified on distinct grounds and at different conditions depending on the different epistemologies which one wishes to endorse, in that each impose different constraints on the methods we adopt to collect and evaluate evidence; (2) such constraints ought to be understood to be different in the case of evidence for risk versus benefit assessment for a series of reasons which I will illustrate on the basis of the recent debate on the causal association between acetaminophen (a.k.a. paracetamol) and asthma.


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Item Type: Published Article or Volume
Creators:
CreatorsEmailORCID
Osimani, Barbarabarbaraosimani@gmail.com0000-0001-5212-9525
Keywords: Causality, Randomized Clinical Tirals, Evidence Hierarchies, Evidence Based Medicine, Clinical methodology Causal inference Scientific inference Induction Abduction Hypothetico-deductive method Precautionary principle Acetaminophen Paracetamol
Subjects: Specific Sciences > Biology
General Issues > Causation
General Issues > Confirmation/Induction
General Issues > Ethical Issues
General Issues > Experimentation
General Issues > History of Science Case Studies
Specific Sciences > Medicine
Specific Sciences > Probability/Statistics
General Issues > Science and Society
General Issues > Science and Policy
General Issues > Technology
General Issues > Theory/Observation
General Issues > Values In Science
Depositing User: Prof. Barbara Osimani
Date Deposited: 30 Dec 2020 15:26
Last Modified: 30 Dec 2020 15:26
Item ID: 12285
Journal or Publication Title: Topoi
Publisher: Springer
Official URL: http://link.springer.com/article/10.1007/s11245-01...
Subjects: Specific Sciences > Biology
General Issues > Causation
General Issues > Confirmation/Induction
General Issues > Ethical Issues
General Issues > Experimentation
General Issues > History of Science Case Studies
Specific Sciences > Medicine
Specific Sciences > Probability/Statistics
General Issues > Science and Society
General Issues > Science and Policy
General Issues > Technology
General Issues > Theory/Observation
General Issues > Values In Science
Date: 2014
Page Range: pp. 295-312
Volume: 33
URI: http://philsci-archive.pitt.edu/id/eprint/12285

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