Catalogue


The philosophy of evidence-based medicine [electronic resource] /
Jeremy Howick ; foreword by Paul Glasziou.
imprint
Chichester, West Sussex, UK : Wiley-Blackwell, BMJ Books, 2011.
description
xiv, 229 p. : ill. ; 22 cm.
ISBN
9781405196673 (pbk. : alk. paper)
format(s)
Book
More Details
imprint
Chichester, West Sussex, UK : Wiley-Blackwell, BMJ Books, 2011.
isbn
9781405196673 (pbk. : alk. paper)
restrictions
Licensed for access by U. of T. users.
contents note
The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness -- Questioning the methodological superiority of "placebo" over "active" controlled trials -- Examining the paradox that traditional roles for mechanistic reasoning and expert -- Judgment have been up-ended by EBM -- A qualified defence of the EBM stance on mechanistic reasoning -- Knowledge that versus knowledge how : situating the EBM position on expert clinical judgment -- Moving EBM forward.
catalogue key
8027659
 
Includes bibliographical references and index.
A Look Inside
About the Author
Author Affiliation
Jeremy Howick, PhD, Centre for Evidence-Based Medicine, Department of Public Health and Primary Care, University of Oxford, and Department of Science and Technology Studies, University College London, UK
Reviews
Review Quotes
"In summary, Howick's book provides a good overview of EBM's defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theor Med Bioeth, 2011) "Students of evidence-based medicine, researchers, and those studying the philosophy of science or medicine are the intended audience. It also may be of interest to practicing clinicians seeking to develop a more in-depth understanding of EBM, its purpose, utility, and limitations." (Doody's, 30 September 2011)
"In summary, Howicks book provides a good overview of EBMs defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theor Med Bioeth, 2011) "Students of evidence-based medicine, researchers, and those studying the philosophy of science or medicine are the intended audience. It also may be of interest to practicing clinicians seeking to develop a more in-depth understanding of EBM, its purpose, utility, and limitations." (Doodys, 30 September 2011)
"Jeremy Howick has written the most comprehensive and fair philosophical treatment of EBM to date. Howick understands that EBM is not, first and foremost, a philosophical position, and that its various components (e.g., evidence hierarchies) are not primarily philosophical theses. Rather, they are attempts to improve the efficacy of medicine.... The book approaches its topic with the tools of mainstream analytical philosophy of science." (Philosophy of Science, 2013) " The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In The Philosophy of Evidence-Based Medicine , Jeremy Howick, PhD offers by far the most fully formed defence to date of the epistemology of EBM.... Well-written and as approachable as any work in the philosophy of science might hope to be.... Howick is to be commended for his careful analysis of epistemic ramifications of many of the methodologies of clinical epidemiology." (Journal of Evaluation in Clinical Practice, 2011) "Howick's book provides a good overview of EBM's defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doody's, 2011)
"Jeremy Howick has written the most comprehensive and fair philosophical treatment of EBM to date. Howick understands that EBM is not, first and foremost, a philosophical position, and that its various components (e.g., evidence hierarchies) are not primarily philosophical theses. Rather, they are attempts to improve the efficacy of medicine.... The book approaches its topic with the tools of mainstream analytical philosophy of science." (Philosophy of Science, 2013) " The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In The Philosophy of Evidence-Based Medicine , Jeremy Howick, PhD offers by far the most fully formed defence to date of the epistemology of EBM.... Well-written and as approachable as any work in the philosophy of science might hope to be.... Howick is to be commended for his careful analysis of epistemic ramifications of many of the methodologies of clinical epidemiology." (Journal of Evaluation in Clinical Practice, 2011) "Howicks book provides a good overview of EBMs defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doodys, 2011)
"The book is well structured and makes an accessible and pleasant read. It deserves to be digested not only by philosophers with a methodological bent but by practitioners of EBM. After two decades of criticisms of various aspects of the increasingly popular EBM way of reasoning, it is about time EBM defenders tried to strike back, clarifying and justifying their positions. Howick's book is a valuable effort that will hopefully enrich the continuing debate." ( Theoria , 1 April 2013) "Jeremy Howick has written the most comprehensive and fair philosophical treatment of EBM to date. Howick understands that EBM is not, first and foremost, a philosophical position, and that its various components (e.g., evidence hierarchies) are not primarily philosophical theses. Rather, they are attempts to improve the efficacy of medicine.... The book approaches its topic with the tools of mainstream analytical philosophy of science." (Philosophy of Science, 2013) " The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In The Philosophy of Evidence-Based Medicine , Jeremy Howick, PhD offers by far the most fully formed defence to date of the epistemology of EBM.... Well-written and as approachable as any work in the philosophy of science might hope to be.... Howick is to be commended for his careful analysis of epistemic ramifications of many of the methodologies of clinical epidemiology." (Journal of Evaluation in Clinical Practice, 2011) "Howick's book provides a good overview of EBM's defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doody's, 2011)
"The book is well structured and makes an accessible and pleasant read. It deserves to be digested not only by philosophers with a methodological bent but by practitioners of EBM. After two decades of criticisms of various aspects of the increasingly popular EBM way of reasoning, it is about time EBM defenders tried to strike back, clarifying and justifying their positions. Howick's book is a valuable effort that will hopefully enrich the continuing debate." ( Theoria , 1 April 2013) "Jeremy Howick has written the most comprehensive and fair philosophical treatment of EBM to date. Howick understands that EBM is not, first and foremost, a philosophical position, and that its various components (e.g., evidence hierarchies) are not primarily philosophical theses. Rather, they are attempts to improve the efficacy of medicine.... The book approaches its topic with the tools of mainstream analytical philosophy of science." (Philosophy of Science, 2013) " The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In The Philosophy of Evidence-Based Medicine , Jeremy Howick, PhD offers by far the most fully formed defence to date of the epistemology of EBM.... Well-written and as approachable as any work in the philosophy of science might hope to be.... Howick is to be commended for his careful analysis of epistemic ramifications of many of the methodologies of clinical epidemiology." (Journal of Evaluation in Clinical Practice, 2011) "Howicks book provides a good overview of EBMs defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doodys, 2011)
"The book is well structured and makes an accessible and pleasant read. It deserves to be digested not only by philosophers with a methodological bent but by practitioners of EBM. After two decades of criticisms of various aspects of the increasingly popular EBM way of reasoning, it is about time EBM defenders tried to strike back, clarifying and justifying their positions. Howick's book is a valuable effort that will hopefully enrich the continuing debate." ( Theoria , 1 April 2013) "Jeremy Howick has written the most comprehensive and fair philosophical treatment of EBM to date. Howick understands that EBM is not, first and foremost, a philosophical position, and that its various components (e.g., evidence hierarchies) are not primarily philosophical theses. Rather, they are attempts to improve the efficacy of medicine.... The book approaches its topic with the tools of mainstream analytical philosophy of science." (Philosophy of Science, 2013) " The Philosophy of Evidence Based Medicine helps answer the question of how to think aboutmedicineso that judgement can be made. The book addresses key questions about medical decision-making, such as: what roleshould mechanistic reasoning have in determining appropriate medical care?And,whatweight, if any,should be given to expert opinions? This isn't abook about howdoctors think. It is about how doctorsoughtto think.... The Philosophy of Evidence Based Medicine isan extremely important and practicalbook about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In The Philosophy of Evidence-Based Medicine , Jeremy Howick, PhD offers by far the most fully formed defence to date of the epistemology of EBM.... Well-written and as approachable as any work in the philosophy of science might hope to be.... Howick is to be commended for his careful analysis of epistemic ramifications of many of the methodologies of clinical epidemiology." (Journal of Evaluation in Clinical Practice, 2011) "Howick's book provides a good overview of EBM's defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doody's, 2011)
" The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In summary, Howick's book provides a good overview of EBM's defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doody's, 2011)
" The Philosophy of Evidence Based Medicine helps answer the question of how to think about medicine so that judgement can be made. The book addresses key questions about medical decision-making, such as: what role should mechanistic reasoning have in determining appropriate medical care? And, what weight, if any, should be given to expert opinions? This isn't a book about how doctors think. It is about how doctors ought to think.... The Philosophy of Evidence Based Medicine is an extremely important and practical book about evidence-based medicine, and I consider it to be one of the most important contemporary books on the subject. I recommend it very highly." (The Medical Media Review, 2012) "In summary, Howicks book provides a good overview of EBMs defense of the hierarchy of evidence and an excellent reference list for readers who want to know more about EBM and its critics." (Theory of Medical Bioethics, 2011) "Since the 1990s, the practice of medicine has become dominated by a new methodological reasoning process - that of evidence-based medicine. This book unpacks the assumptions inherent in this methodology, shedding light on its contributions and limitations to patient care. It addresses misconceptions about and criticisms of EBM in a cogent manner and provides valuable insight into how the current world of medicine is being shaped. (Doodys, 2011)
This item was reviewed in:
Doody's Reviews, October 2011
To find out how to look for other reviews, please see our guides to finding book reviews in the Sciences or Social Sciences and Humanities.
Summaries
Back Cover Copy
The controversy surrounding the significance of evidence-based medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own. This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidence-based medicine: Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts? Students of evidence-based medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today's more patient-centred approach. Titles of Related Interest Clinical Thinking: Evidence, Communication and Decision-Making Chris Del Mar, Jenny Doust, Paul P. Glasziou ISBN: 978-0-7279-1741-6 Evidence-based Decisions and Economics: Health care, social welfare, education and criminal justice, 2nd Edition Ian Shemilt, Miranda Mugford, Luke Vale, Kevin Marsh and Cam Donaldson ISBN 978-1-4051-9153-1
Back Cover Copy
The controversy surrounding the significance of evidence-based medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own. This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidence-based medicine: Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts? Students of evidence-based medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today’s more patient-centred approach. Titles of Related Interest Clinical Thinking: Evidence, Communication and Decision-Making Chris Del Mar, Jenny Doust, Paul P. Glasziou ISBN: 978-0-7279-1741-6 Evidence-based Decisions and Economics: Health care, social welfare, education and criminal justice, 2nd Edition Ian Shemilt, Miranda Mugford, Luke Vale, Kevin Marsh and Cam Donaldson ISBN 978-1-4051-9153-1
Back Cover Copy
The controversy surrounding the significance of evidence-based medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own.This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidence-based medicine: Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts?Students of evidence-based medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today's more patient-centred approach. Titles of Related Interest Clinical Thinking: Evidence, Communication and Decision-MakingChris Del Mar , Jenny Doust , Paul P. Glasziou
Bowker Data Service Summary
Evidence-based medicine (EBM) has become a required element of clinical practice, but it is critical for the healthcare community to understand the ongoing controversy surrounding EBM. Seeking to address questions raised by critics, This book challenges the over dependency of EBM on randomised controlled trials.
Long Description
The controversy surrounding the significance of evidencebased medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own. This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidencebased medicine: & Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts? Students of evidencebased medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today&'s more patientcentred approach.& Long Description
The controversy surrounding the significance of evidencebased medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own. This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidencebased medicine: & Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts? Students of evidencebased medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today&'s more patientcentred approach.& & Titles of Related Interest & Clinical Thinking: Evidence, Communication and DecisionMaking Chris Del Mar, Jenny Doust, Paul P. Glasziou ISBN: 9780727917416 & Evidencebased Decisions and Economics: Health care, social welfare, education and criminal justice, 2nd Edition Ian Shemilt, Miranda Mugford, Luke Vale, & Kevin Marsh and Cam Donaldson ISBN 9781405191531& & &
Main Description
Evidence-based medicine (EBM) has become a required element of clinical practice, but it is critical for the healthcare community to understand the ongoing controversy surrounding EBM. Seeking to address questions raised by critics, The Philosophy of Evidence-based Medicine challenges the over dependency of EBM on randomized controlled trials. This book also explores EBM methodology and its relationship with other approaches used in medicine.
Main Description
The controversy surrounding the significance of evidence based medicine (EBM) in clinical practice, far from abating, has grown and developed a momentum of its own. This book examines the arguments for and against EBM being a new paradigm in medicine, and puts together the most coherent and compelling case as to how and why its rigor should be applied to every facet of patient care; discussing the questions often raised by critics of evidence based medicine: Why should EBM dominate health care, from daily medical practice to funding treatments? Is it truly objective? Do we need randomized trials for treatments that are universally accepted as effective? Does EBM serve the needs of individual patients? What part do basic sciences play in EBM? Are randomized trials more important than clinical experts? Students of evidence-based, medicine, researchers and those studying the philosophy of science or medicine will find this detailed treatise an invaluable reference to the development of EBM, from recognition of the validity of randomized controlled trials to today's more patient centred approach. Book jacket.
Table of Contents
Acknowledgmentsp. ix
Forewordp. xi
Prefacep. xiii
Introduction
The philosophy of evidence-based medicinep. 3
What on earth was medicine based on before evidence-based medicine?p. 3
Scope of the bookp. 7
How the claims of EBM will be examinedp. 8
Structure of what is to comep. 8
What is EBM?p. 10
EBM as a self-proclaimed Kuhnian paradigmp. 10
The motivation for the birth of EBM: a sketchp. 11
Original definition of EBMp. 15
Reaction to criticism of the EBM system of evidence: more subtle, more or less the samep. 20
What is good evidence for a clinical decision?p. 24
Introductionp. 24
Evidence for clinical effectivenessp. 25
Strong evidence tells us what?p. 29
Do randomization, double masking, and placebo controls rule out more confounding factors than their alternatives?
Ruling out plausible rival hypotheses and confounding factors: a methodp. 33
Resolving the paradox of effectiveness: when do observational studies offer the same degree of evidential support as randomized trials?p. 39
The paradox of effectivenessp. 39
Observational studies: definition and problemsp. 40
Randomized trials to the rescuep. 43
Defending the EBM view that randomized trials provide better evidence than observational studiesp. 48
Overcoming the paradox of effectivenessp. 56
Conclusion: a more subtle way to distinguish between high- and low-quality comparative clinical studiesp. 59
types of restricted randomizationp. 60
Worrall's arguments that randomization is required for classical hypothesis testing and establishing probabilistic causesp. 61
Questioning double blinding as a universal methodological virtue of clinical trials: resolving the Philip's paradoxp. 63
The problems with double masking as a requirement for clinical trial validityp. 63
The many faces of double masking: clarifying the terminologyp. 65
Confounders that arise from participant and caregiver knowledgep. 66
The importance of successful double maskingp. 69
One (and a half) solutions to the Philip's paradoxp. 75
The full solution to the Philip's paradox: challenging the view that double masking rules out confounding factors when treatments are evidently dramaticp. 76
Double masking is valuable unless the treatment effects are evidently dramatic, hence the Philip's paradox does not arisep. 78
Placebo controls: problematic and misleading baseline measures of effectivenessp. 80
The need to control the placebop. 80
Legitimate placebo controlsp. 82
How placebo controls often violate the first condition for legitimacyp. 83
How placebo controls often violate the second condition for legitimacyp. 86
Special problem for constructing placebos for complex treatments: case studies of exercise and acupuncturep. 87
Summary and solution to the problem with illegitimate placebo controlsp. 94
Questioning the methodological superiority of "placebo" over "active" controlled trialsp. 96
Epistemological foundations of the ethical debate over the use of placebo-controlled trialsp. 96
Problems with the assay sensitivity arguments against ACTsp. 98
Problems with the first assay sensitivity argument against ACTsp. 98
The second assay sensitivity argumentp. 106
Challenging the view that PCTs provide a measure of absolute effect sizep. 107
Questioning the claim that PCTs require smaller sample sizesp. 112
Conclusion: a reassessment of the relative methodological quality of PCTsp. 113
Appendix: more detailed explanation of why the second assay sensitivity argument failsp. 114
Examining the paradox that traditional roles for mechanistic reasoning and expert judgment have been up-ended by EBM
Transition to Part IIIp. 119
Summary of Part IIp. 119
Introduction to Part IIIp. 120
A qualified defence of the EBM stance on mechanistic reasoningp. 122
A tension between proponents of mechanistic reasoning and EBM viewsp. 122
Clarifying the terminology: comparative clinical studies, mechanisms, and mechanistic reasoningp. 124
Why the strong view that mechanistic reasoning is necessary to establish causal claims is mistakenp. 130
Two epistemological problems with mechanistic reasoningp. 136
Why EBM proponents should allow a more prominent role for high-quality (valid and based on "complete" mechanisms) mechanistic reasoning in their evidence hierarchiesp. 143
Mechanisms and other roles in clinical medicinep. 146
Recommending a (slightly) more important role for mechanistic reasoning in the EBM systemp. 153
Appendix: cases where mechanistic reasoning led to the adoption of therapies that were either useless or harmful according to well-conducted clinical researchp. 154
Knowledge that versus knowledge how: situating the EBM position on expert clinical judgmentp. 158
Controversies surrounding the EBM stance on expert clinical judgementp. 158
General clinical judgment belongs at the bottom of (or off) the hierarchy of evidencep. 161
Individual clinical judgment also belongs at the bottom of the hierarchyp. 167
The equally important non-evidential roles of expertisep. 176
Conclusionp. 182
Conclusions
Moving EBM forwardp. 187
Summary of findings: the EBM philosophy is acceptable, but. . .p. 187
Two new frontiers for EBMp. 189
Referencesp. 193
Indexp. 225
Table of Contents provided by Ingram. All Rights Reserved.

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