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Philosophical Issues in Medical Intervention Research
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.ORCID iD: 0000-0001-9373-3067
2015 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The thesis consists of an introduction and two papers. In the introduction a brief historical survey of empirical investigations into the effectiveness of medicinal interventions is given. Also, the main ideas of the EBM (evidence-based medicine) movement are presented. Both included papers can be viewed as investigations into the reasonableness of EBM and its hierarchies of evidence.

Paper I: Typically, in a clinical trial patients with specified symptoms are given either of two or more predetermined treatments. Health endpoints in these groups are then compared using statistical methods. Concerns have been raised, not least from adherents of so-called alternative medicine, that clinical trials do not offer reliable evidence for some types of treatment, in particular for highly individualized treatments, for example traditional homeopathy. It is argued that such concerns are unfounded. There are two minimal conditions related to the nature of the treatments that must be fulfilled for evaluability in a clinical trial, namely (1) the proper distinction of the two treatment groups and (2) the elimination of confounding variables or variations. These are delineated, and a few misunderstandings are corrected. It is concluded that the conditions do not preclude the testing of alternative medicine, whether individualized or not.

Paper II: Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM literature, although some recent authors have argued for an upgrading. Even so, mechanistic reasoning that has received attention has almost exclusively been positive -- both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessing medical interventions. Although this definition is wider than a previous suggestion in the literature, there are still other instances of reasoning that concern mechanisms but do not (and should not) count as mechanistic reasoning. One of the three distinguished types, which is negative only in the health-related sense, has a corresponding positive counterpart, whereas the other two, which are epistemically negative, do not have such counterparts, at least not that are particularly interesting as evidence. Accounting for negative mechanistic reasoning in EBM is therefore partly different from accounting for positive mechanistic reasoning. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to the typical strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and presents a serious challenge to proponents of so-called medical hierarchies of evidence.

Place, publisher, year, edition, pages
Stockholm: Kungliga Tekniska högskolan, 2015. , 42 p.
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831 ; 53
Keyword [en]
scientific method, study design, methodology, alternative medicine, medical research, individualized treatments, eligibility, confounders, evidence, evidence-based medicine, mechanistic reasoning, hierarchy of evidence
National Category
Philosophy
Research subject
Philosophy
Identifiers
URN: urn:nbn:se:kth:diva-163872ISBN: 978-91-7595-423-3 (print)OAI: oai:DiVA.org:kth-163872DiVA: diva2:802578
Presentation
2015-04-28, Seminarierummet, Avd. för Filosofi, Brinellvägen 32, Stockholm, 13:00 (English)
Opponent
Supervisors
Note

QC 20150413

Available from: 2015-04-13 Created: 2015-04-13 Last updated: 2015-04-13Bibliographically approved
List of papers
1. Why alternative medicine can be scientifically evaluated: Countering the evasions of pseudoscience
Open this publication in new window or tab >>Why alternative medicine can be scientifically evaluated: Countering the evasions of pseudoscience
2013 (English)In: Philosophy of Pseudoscience: Reconsidering the Demarcation Problem / [ed] Massimo Pigliucci & Maarten Boudry, Chicago: University of Chicago Press, 2013, 305-320 p.Chapter in book (Refereed)
Abstract [en]

Typically, in a clinical trial patients with specified symptoms are given either of two predetermined treatments. Health endpoints in the two groups are then compared using statistical methods. Concerns have been raised, not least from adherents of so-called alternative medicine, that clinical trials do not offer reliable evidence for some types of treatment, in particular for highly individualized treatments, for example traditional homeopathy. It is argued that such concerns are unfounded. There are two minimal conditions related to the nature of the treatments that must be fulfilled for eligibility to a clinical trial, namely (1) the proper distinction of the two treatment groups and (2) the elimination of confounding variables or variations. These are delineated, and a few misunderstandings are corrected. It is concluded that the conditions do not preclude the testing of alternative medicine, whether individualized or not.

Place, publisher, year, edition, pages
Chicago: University of Chicago Press, 2013
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-87649 (URN)9780226051796 (ISBN)9780226051963 (ISBN)
Note

QC 20131104

Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2015-04-13Bibliographically approved
2. Negative mechanistic reasoning in medical intervention assessment
Open this publication in new window or tab >>Negative mechanistic reasoning in medical intervention assessment
2015 (English)In: Theoretical Medicine and Bioethics, ISSN 1386-7415, E-ISSN 1573-0980, Vol. 36, no 6, 425-437 p.Article in journal (Refereed) Published
Abstract [en]

Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM (evidence-based medicine) literature, although some recent authors have argued for an upgrading. Even so, mechanistic reasoning that has received attention has almost exclusively been positive – both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessing medical interventions. This definition is wider than a previous suggestion in the literature. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to the typical evidential strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and presents a serious challenge to proponents of so-called medical hierarchies of evidence.

Place, publisher, year, edition, pages
Springer Netherlands, 2015
Keyword
mechanistic reasoning, evidence-based medicine, hierarchy of evidence
National Category
Philosophy
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-163867 (URN)10.1007/s11017-015-9348-2 (DOI)000365783100004 ()2-s2.0-84948386104 (Scopus ID)
Note

QC 20151211

Available from: 2015-04-13 Created: 2015-04-13 Last updated: 2017-12-04Bibliographically approved

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