Andersen, Holly (2012) Mechanisms: what are they evidence for in evidence-based medicine? Journal of Evaluation in Clinical Practice, 18. pp. 992-999.
![[img]](https://philsci-archive.pitt.edu/style/images/fileicons/application_pdf.png)
|
PDF
Mechanisms_in_EBM_preprint.pdf Download (148kB) |
Abstract
Even though the evidence-based medicine (EBM) movement labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population-level recommendations to indi- vidual patients. Thus, even though the evidence-based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of EBM who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms.
| Export/Citation: | EndNote | BibTeX | Dublin Core | ASCII/Text Citation (Chicago) | HTML Citation | OpenURL |
| Social Networking: |
| Item Type: | Published Article or Volume | ||||||
|---|---|---|---|---|---|---|---|
| Creators: |
|
||||||
| Keywords: | mechanisms; explanation; medicine; evidence-based medicine | ||||||
| Subjects: | General Issues > Causation General Issues > Explanation Specific Sciences > Medicine |
||||||
| Depositing User: | Dr. Holly Andersen | ||||||
| Date Deposited: | 13 Mar 2013 13:38 | ||||||
| Last Modified: | 13 Mar 2013 13:38 | ||||||
| Item ID: | 9619 | ||||||
| Journal or Publication Title: | Journal of Evaluation in Clinical Practice | ||||||
| Official URL: | http://onlinelibrary.wiley.com/store/10.1111/j.136... | ||||||
| DOI or Unique Handle: | 10.1111/j.1365-2753.2012.01906.x | ||||||
| Subjects: | General Issues > Causation General Issues > Explanation Specific Sciences > Medicine |
||||||
| Date: | 2012 | ||||||
| Page Range: | pp. 992-999 | ||||||
| Volume: | 18 | ||||||
| URI: | https://philsci-archive.pitt.edu/id/eprint/9619 |
Monthly Views for the past 3 years
Monthly Downloads for the past 3 years
Plum Analytics
Altmetric.com
Actions (login required)
 |
View Item |
![[feed]](http://philsci-archive.pitt.edu/style/images/feed-icon-32x32.png){kind=icon}