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Philosophy of Evidence-Based Medicine

ISBN-10: 140519667X

ISBN-13: 9781405196673

Edition: 2011

Authors: Jeremy H. Howick

List price: $44.99
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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.
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Book details

List price: $44.99
Copyright year: 2011
Publisher: John Wiley & Sons, Limited
Publication date: 4/5/2011
Binding: Paperback
Pages: 244
Size: 5.50" wide x 8.50" long x 0.75" tall
Weight: 0.660
Language: English

Acknowledgments
Foreword
Preface
Introduction
The philosophy of evidence-based medicine
What on earth was medicine based on before evidence-based medicine?
Scope of the book
How the claims of EBM will be examined
Structure of what is to come
What is EBM?
EBM as a self-proclaimed Kuhnian paradigm
The motivation for the birth of EBM: a sketch
Original definition of EBM
Reaction to criticism of the EBM system of evidence: more subtle, more or less the same
What is good evidence for a clinical decision?
Introduction
Evidence for clinical effectiveness
Strong evidence tells us what?
Do randomization, double masking, and placebo controls rule out more confounding factors than their alternatives?
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?
The paradox of effectiveness
Observational studies: definition and problems
Randomized trials to the rescue
Defending the EBM view that randomized trials provide better evidence than observational studies
Overcoming the paradox of effectiveness
Conclusion: a more subtle way to distinguish between high- and low-quality comparative clinical studies
types of restricted randomization
Worrall's arguments that randomization is required for classical hypothesis testing and establishing probabilistic causes
Questioning double blinding as a universal methodological virtue of clinical trials: resolving the Philip's paradox
The problems with double masking as a requirement for clinical trial validity
The many faces of double masking: clarifying the terminology
Confounders that arise from participant and caregiver knowledge
The importance of successful double masking
One (and a half) solutions to the Philip's paradox
The full solution to the Philip's paradox: challenging the view that double masking rules out confounding factors when treatments are evidently dramatic
Double masking is valuable unless the treatment effects are evidently dramatic, hence the Philip's paradox does not arise
Placebo controls: problematic and misleading baseline measures of effectiveness
The need to control the placebo
Legitimate placebo controls
How placebo controls often violate the first condition for legitimacy
How placebo controls often violate the second condition for legitimacy
Special problem for constructing placebos for complex treatments: case studies of exercise and acupuncture
Summary and solution to the problem with illegitimate placebo controls
Questioning the methodological superiority of "placebo" over "active" controlled trials
Epistemological foundations of the ethical debate over the use of placebo-controlled trials
Problems with the assay sensitivity arguments against ACTs
Problems with the first assay sensitivity argument against ACTs
The second assay sensitivity argument
Challenging the view that PCTs provide a measure of absolute effect size
Questioning the claim that PCTs require smaller sample sizes
Conclusion: a reassessment of the relative methodological quality of PCTs
Appendix: more detailed explanation of why the second assay sensitivity argument fails
Examining the paradox that traditional roles for mechanistic reasoning and expert judgment have been up-ended by EBM
Transition to Part III
Summary of Part II
Introduction to Part III
A qualified defence of the EBM stance on mechanistic reasoning
A tension between proponents of mechanistic reasoning and EBM views
Clarifying the terminology: comparative clinical studies, mechanisms, and mechanistic reasoning
Why the strong view that mechanistic reasoning is necessary to establish causal claims is mistaken
Two epistemological problems with mechanistic reasoning
Why EBM proponents should allow a more prominent role for high-quality (valid and based on "complete" mechanisms) mechanistic reasoning in their evidence hierarchies
Mechanisms and other roles in clinical medicine
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
Knowledge that versus knowledge how: situating the EBM position on expert clinical judgment
Controversies surrounding the EBM stance on expert clinical judgement
General clinical judgment belongs at the bottom of (or off) the hierarchy of evidence
Individual clinical judgment also belongs at the bottom of the hierarchy
The equally important non-evidential roles of expertise
Conclusion
Conclusions
Moving EBM forward
Summary of findings: the EBM philosophy is acceptable, but. . .
Two new frontiers for EBM
References
Index