Unit:
Κατεύθυνση Ιστορία και Φιλοσοφία των Επιστημών και της ΤεχνολογίαςLibrary of the School of Science
Author:
Koumpos Achilleas
Supervisors info:
Στάθης Ψύλλος, Καθηγητής, Τμήμα Ιστορίας και Φιλοσοφίας της Επιστήμης, Σχολή Θετικών Επιστημών, ΕΚΠΑ
Κωνσταντίνος Δημητρακόπουλος, Καθηγητής, Τμήμα Ιστορίας και Φιλοσοφίας της Επιστήμης, Σχολή Θετικών Επιστημών, ΕΚΠΑ
Ελένη Μανωλακάκη, Καθηγήτρια, Τμήμα Ιστορίας και Φιλοσοφίας της Επιστήμης, Σχολή Θετικών Επιστημών, ΕΚΠΑ
Original Title:
Το Τεκμήριο των Μηχανισμών στην Ιατρική
Translated title:
evidence of mechanisms in medicine
Summary:
Since the early 1990s, Randomized Control Trials (RCTs) and statistical
correlations, resulting from these studies, are considered to provide the strongest and
most reliable evidence base by which causal inferences can be drawn in medicine.
Since then, the Evidence Based Medicine (EBM) movement has placed clinical trials
(RCTs, systematic reviews, meta-analyzes) at the top of the pyramid in terms of their
role and assistance in making clinical decisions. However, clinical researchers, and
especially philosophers of science, have noticed and pointed out many limitations and
problems of randomization (logical, design, performance, etc.) resulting in a shattered
belief in the evidence of correlation. On the other hand, and in the light of the new
research conducted in the field of mechanisms, their supporters believe that they have
good reasons to revise (upwards) their evidential value that is still placed at the
bottom of the pyramid. In this essay we will examine what exactly the "mechanisms"
mean in medicine, what problems of definition exist, which are their virtues and what
criticism has been passed in order to deduct in some more general conclusions.
In this discussion on evidence in medicine and given the complexity of biomedical
processes, we are gradually reaching a more pluralistic approach of causality, that is,
to answering the basic question, "what causes what". Since the discovery of causes is
extremely useful in medicine because it helps in treatment of diseases, in prevention
but also in implementation of health policies, an evidential pluralism seems more
reasonable and could satisfy the requirements of safety and effectiveness in medicine
since for when we know the cause we are able to make better clinical decisions.
Main subject category:
Science
Other subject categories:
Philosophy - Psychology
Keywords:
mechanisms, evidence of mechanism, statistical evidence, randomization, causation in medicine, Evidence-based medicine
Number of references:
109
