The philosophy of evidence-based medicine
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| Author / Creator: | HOWICK, JEREMY. |
|---|---|
| Imprint: | Chichester, West Sussex, UK : Wiley-Blackwell, BMJ Books, 2011. |
| Description: | 1 online resource. |
| Language: | English |
| Subject: | |
| Format: | E-Resource Book |
| URL for this record: | http://pi.lib.uchicago.edu/1001/cat/bib/8436256 |
Table of Contents:
- Acknowledgments
- Foreword
- Preface
- Part I. Introduction
- 1. The philosophy of evidence-based medicine
- 1.1. What on earth was medicine based on before evidence-based medicine?
- 1.2. Scope of the book
- 1.3. How the claims of EBM will be examined
- 1.4. Structure of what is to come
- 2. What is EBM?
- 2.1. EBM as a self-proclaimed Kuhnian paradigm
- 2.2. The motivation for the birth of EBM: a sketch
- 2.3. Original definition of EBM
- 2.4. Reaction to criticism of the EBM system of evidence: more subtle, more or less the same
- 3. What is good evidence for a clinical decision?
- 3.1. Introduction
- 3.2. Evidence for clinical effectiveness
- 3.3. Strong evidence tells us what?
- Part II. Do randomization, double masking, and placebo controls rule out more confounding factors than their alternatives?
- 4. Ruling out plausible rival hypotheses and confounding factors: a method
- 5. Resolving the paradox of effectiveness: when do observational studies offer the same degree of evidential support as randomized trials?
- 5.1. The paradox of effectiveness
- 5.2. Observational studies: defi nition and problems
- 5.3. Randomized trials to the rescue
- 5.4. Defending the EBM view that randomized trials provide better evidence than observational studies
- 5.5. Overcoming the paradox of effectiveness
- 5.6. Conclusion: a more subtle way to distinguish between high- and low-quality comparative clinical studies
- Appendix 1. ypes of restricted randomization
- Appendix 2. Worrall's arguments that randomization is required for classical hypothesis testing and establishing probabilistic causes
- 6. Questioning double blinding as a universal methodological virtue of clinical trials: resolving the Philip's paradox
- 6.1. The problems with double masking as a requirement for clinical trial validity
- 6.2. The many faces of double masking: clarifying the terminology
- 6.3. Confounders that arise from participant and caregiver knowledge
- 6.4. The importance of successful double masking
- 6.5. One (and a half) solutions to the Philip's paradox
- 6.6. The full solution to the Philip's paradox: challenging the view that double masking rules out confounding factors when treatments are evidently dramatic
- 6.7. Double masking is valuable unless the treatment effects are evidently dramatic, hence the Philip's paradox does not arise
- 7. Placebo controls: problematic and misleading baseline measures of effectiveness
- 7.1. The need to control the placebo
- 7.2. Legitimate placebo controls
- 7.3. How placebo controls often violate the fi rst condition for legitimacy
- 7.4. How placebo controls often violate the second condition for legitimacy
- 7.5. Special problem for constructing placebos for complex treatments: case studies of exercise and acupuncture
- 7.6. Summary and solution to the problem with illegitimate placebo controls
- 8. Questioning the methodological superiority of "placebo" over "active" controlled trials
- 8.1. Epistemological foundations of the ethical debate over the use of placebo-controlled trials
- 8.2. Problems with the assay sensitivity arguments against ACTs
- 8.3. Problems with the fi rst assay sensitivity argument against ACTs
- 8.4. The second assay sensitivity argument
- 8.5. Challenging the view that PCTs provide a measure of absolute effect size
- 8.6. Questioning the claim that PCTs require smaller sample sizes
- 8.7. Conclusion: a reassessment of the relative methodological quality of PCTs
- Appendix: more detailed explanation of why the second assay sensitivity argument fails
- Part III. Examining the paradox that traditional roles for mechanistic reasoning and expert judgment have been up-ended by EBM
- 9. Transition to Part III
- 9.1. Summary of Part II
- 9.2. Introduction to Part III
- 10. A qualifi ed defence of the EBM stance on mechanistic reasoning
- 10.1. A tension between proponents of mechanistic reasoning and EBM views
- 10.2. Clarifying the terminology: comparative clinical studies, mechanisms, and mechanistic reasoning
- 10.3. Why the strong view that mechanistic reasoning is necessary to establish causal claims is mistaken
- 10.4. Two epistemological problems with mechanistic reasoning
- 10.5. Why EBM proponents should allow a more prominent role for high-quality (valid and based on "complete" mechanisms) mechanistic reasoning in their evidence hierarchies
- 10.6. Mechanisms and other roles in clinical medicine
- 10.7. Recommending a (slightly) more important role for mechanistic reasoning in the EBM system
- Appendix: cases where mechanistic reasoning led to the adoption of therapies that were either useless or harmful according to well-conducted clinical research
- 11. Knowledge that versus knowledge how: situating the EBM position on expert clinical judgment
- 11.1. Controversies surrounding the EBM stance on expert clinical judgement
- 11.2. General clinical judgment belongs at the bottom of (or off) the hierarchy of evidence
- 11.3. Individual clinical judgment also belongs at the bottom of the hierarchy
- 11.4. The equally important non-evidential roles of expertise
- 11.5. Conclusion
- Part IV. Conclusions
- 12. Moving EBM forward
- 12.1. Summary of fi ndings: the EBM philosophy is acceptable, but
- 12.2. Two new frontiers for EBM
- References
- Index
