ARE WE SATISFIED WITH TREATING THE MERE SYMPTOMS OF MEDICALLY UNEXPLAINED SYNDROMES?

by Karin Mohn Engebretsen, Better Evidence for a Better Healthcare Manifesto

As a Gestalt psychotherapist, I have seen an increasing number of individuals over the last fifteen years that experience themselves as burned out. This fact has triggered my interest to explore the phenomenon further. Burnout is as a medically unexplained syndrome (MUS). As with other MUS, there is a tendency to assume a narrow perspective to focus on problems related to psyche or soma as pathologies located exclusively within the patient. Research has mainly looked for clear-cut one-to-one relations between cause and effect. These relationships are however difficult to find in complex syndromes. (more…)

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THE BEST EVIDENCE TENDS TO GET THE FACTS RIGHT

by Stephen Mumford, Better Evidence for a Better Healthcare Manifesto

Science is a normative enterprise, it should be acknowledged, and this applies just as much to medical research. We need to know how empirical knowledge should be gathered. What methods and techniques should we employ in order for our results to be considered scientific? Indeed, we can think of the term ‘scientific’ as an honorific bestowed upon certain claims when they have been discovered and substantiated in the right way. It is plausible that science is actually constituted by the set of norms for its proper conduct. (more…)

EXPERTISE IS MORE THAN AUTHORITY

by Samantha Copeland, Better Evidence for Better Healthcare Manifesto

One of the key criticisms of the EBM movement as it has taken shape is that the hierarchies the movement has embraced have placed clinical expertise and localized knowledge at their bottom. This was a reaction to one of EBM’s general aims, to move medicine away from the old habit of simply following authority and into a new era of using good evidence to guide medical decisions. But clinical expertise and blindly following or expressing authority are not the same thing, and I and others think it has been a mistake of EBM to take that assumption and run with it into the arms of the RCT. (more…)

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…)

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…)

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…)