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Mechanisms: what are they evidence for in evidence-based medicine?

Andersen, Holly (2012) Mechanisms: what are they evidence for in evidence-based medicine? Journal of Evaluation in Clinical Practice, 18. pp. 992-999.

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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.


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Item Type: Published Article or Volume
Creators:
CreatorsEmailORCID
Andersen, Hollyholly_andersen@sfu.ca
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: https://doi.org/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-dev.library.pitt.edu/id/eprint/9619

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