Philosophy

What Evidence? Reflections on Better Evidence for Better Healthcare

by Rani Lill Anjum, Better Evidence for Better Healthcare Manifesto

CauseHealth offers a new ontological foundation for medicine, what we call Causal Dispositionalism (Mumford and Anjum 2011). From this perspective, better evidence would mean evidence of causation, understood as something tendential and intrinsic. Specifically, better evidence of causation would involve theoretical understanding of how and why an intervention brings about a certain effect. But we should try to develop this understanding to also include how various factors interact, for instance, what could counteract the effect, what could enforce it and what else is causally relevant for the outcome. (more…)

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Better Evidence for Better Healthcare Manifesto: the CauseHealth Perspective.

The “Better Evidence for Better Healthcare Manifesto” initiative was recently launched by the Oxford Centre for Evidence Based Medicine (CEBM) in collaboration with the British Medical Journal (BMJ).

The manifesto is motivated by a series of problems and blind spots in the implementation of EBM: lack of high quality evidence, systematic research errors, under-reporting of harm, insufficient inclusion of patient’s priorities are some of the issues named by the Manifesto’s promoters. The purpose of the initiative is to spot what could be changed and how, in order to improve the current situation. (more…)

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Evidence synthesis in pharmacology

By Elena Rocca

Pharmacology is a complex science that aims to balance harm and benefit of treatments for the individual patient. How should different types of evidence be synthesised in order to optimize this task? Should evidence from randomized trials be prioritized over other evidence, following the EBM model? If not, how can different types of evidence be amalgamated in an alternative way? (more…)

What is the form of causation in health and disease, and intervention?

By David Evans

In a paper with a very long title, recently published in Medicine Health Care and Philosophy, Roger Kerry, Nic Lucas and I set out some ideas about how causation applies to relationships between health and disease. In particular, we focused on how treatment (intervention) might act to limit disease and restore health. (more…)

Thinking about guidelines

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National Geographic Wild, Trafalgar Square in London, January 28, 2016.

On October 24, 2016, the CauseHealth crowd met with a small group of other philosophers, healthcare practitioners, and members of the guidelines community. We had a rousing discussion that lasted the whole day, with few pauses and enthusiastic participation from all in attendance. We talked about several issues with how guidelines are developed and implemented and how we thought philosophy could be relevant in solving those issues.

It is difficult to summarize the discussion in a few words—the topics were wide-ranging and participants shared complex ideas from multiple perspectives. I’m going to highlight here some of the themes that came up more than once, and to give an idea of where the group thought the discussion should go next.

Read more of Samantha’s review of the workshop
Read Rani on Real v. Ideal Guidelines
Read Elena on How Decisions are Made
Read Karin on the Ethics of Reduction
Read Stephen on the Notion of Guideline
Read Roger on the Challenges to Come
Read Fiona on Guidelines in Situ
Read Sarah on Truth, Simplicity and Personalization
Read Anna Luise on Challenging Multi-Morbidity
Read Stephen on Standards for Regulation
Read Samantha on Analogies and High-Stakes Inferences
(more…)

Reductionism isn’t enough for public health

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Chinese medical poster, 1933 (ref US NLM; image source here)

By Håkon Boman Andresen

The overarching goal of the public health sciences is to increase the population’s health. Society spends a lot of money each year on health research, which again is used to develop public policies and guidelines. However, is this causing the population to have better health? (more…)