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Evidence of biological mechanisms and health predictions: an insight into clinical reasoning

Pérez-González, Saúl and Rocca, Elena (2022) Evidence of biological mechanisms and health predictions: an insight into clinical reasoning. Perspectives in Biology and Medicine, 65 (1). pp. 89-105.

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Abstract

Traditionally, understanding biological mechanisms has had a central role in clinical reasoning. With the raise of the evidence-based paradigm, however, such role has been under debate. On the one hand, evidence of pathophysiological mechanisms has been de-emphasised in clinical guidelines. This is often motivated by the unreliability of our understanding of complex biological mechanisms. On the other hand, evidence of mechanisms has been defended by some scholars as key to clinical practice. Here, we assess the relevance of evidence of biological mechanisms in two types of clinical predictions: predictions about efficacy and predictions about safety of a certain intervention for the particular patient. Further on, for each type of prediction, we analyse separately two roles that evidence of mechanisms might have, confirming and disconfirming, depending on whether or not it supports that certain epidemiological results apply to the single patient. We argue that the ‘unreliability because of incompleteness’ argument against the emphasis on mechanistic clinical thinking only applies to some of the considered cases. We conclude by offering a model for a more granular view of the role of mechanistic thinking in clinical practice.


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Item Type: Published Article or Volume
Creators:
CreatorsEmailORCID
Pérez-González, Saúlsaul.perez@uv.es0000-0001-9594-9558
Rocca, Elenaelena.rocca@oslomet.no000-0002-5222-0238
Keywords: Evidence of mechanism, evidence based medicine, clinical reasoning, predictions, safety, efficacy
Subjects: General Issues > Causation
General Issues > Evidence
General Issues > Explanation
Specific Sciences > Medicine
Depositing User: Dr Elena Rocca
Date Deposited: 20 Mar 2022 03:43
Last Modified: 20 Mar 2022 03:43
Item ID: 20364
Journal or Publication Title: Perspectives in Biology and Medicine
Publisher: Johns Hopkins University Press
Official URL: https://www.muse.jhu.edu/article/850519
DOI or Unique Handle: muse.jhu.edu/article/850519
Subjects: General Issues > Causation
General Issues > Evidence
General Issues > Explanation
Specific Sciences > Medicine
Date: 17 March 2022
Page Range: pp. 89-105
Volume: 65
Number: 1
URI: https://philsci-archive-dev.library.pitt.edu/id/eprint/20364

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