Dispositions and the Unique Patient

Anjum, Rani Lill

doi:10.1007/978-3-030-41239-5_2

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…Establishing causation is here strongly tied to statistics and quantification, and to establish cause in the individual case, one must be able to deduce an event in an individual from law‐like, general knowledge about such cases 34 . This view goes back to early empiricism, and is congruent with a regularity view of causation and the related probabilistic view, and may also be called empiricist or positivist 33–36 …”

Section: Resultsmentioning

confidence: 98%

How precision medicine changes medical epistemology: A formative case from Norway

Vogt

Hofmann

2022

Evaluation Clinical Practice

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Rationale and Aims Precision medicine (PM) raises a key question: How do we know what works when the number of people with a health problem becomes small or one (n = 1)? We here present a formative case from Norway. The Norwegian Board of Health Supervision was faced with a cancer patient, who had improved after treatment with a drug in the private health sector but was refused continued treatment in the public health service due to lack of clinical trial evidence. The Board overturned this decision, arguing that the drug had been unambiguously documented to work in the individual case. We aim to provide an in‐depth analysis of this case and The Board's decision and thereby to illustrate and elucidate key epistemological and ethical issues and developments in PM. Method We provide our analysis and discussion using tools of critical thinking and concepts from philosophy of science and medicine, such as uncertainty, evidence, forms of inference and causation. We also examine the case in light of the history of evidence‐based medicine (EBM). Results and Discussion The case reflects an epistemological shift in medicine where PM puts greater emphasis on evidence that arises in individual patients after the treatment is provided over pre‐existing population‐based evidence. PM may rely more heavily on abduction to decide what works and qualitative, rather than quantitative judgements. The case also illustrates a possible shift in the concept of causation from regularity accounts to mechanistic and process accounts. We discuss the ethical implications of a shift from more ‘traditional’ to ‘personalised EBM’. Conclusion A framework that is more based on abductions and evidence arising in the individual case has problems in creating quantifiable, reliable and generalisable evidence, and in promoting transparency and accountability. PM currently lacks clear criteria for deciding what works in an individual, posing ethical challenges.

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Section: Resultsmentioning

confidence: 98%

How precision medicine changes medical epistemology: A formative case from Norway

Vogt

Hofmann

2022

Evaluation Clinical Practice

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“…Causes as dispositions act together in producing certain effects. One way of stating this is that dispositions have manifestation partners that produce an effect when acting together (Anjum, 2020 ). Causation then implies both singularity and complexity.…”

Section: Causationmentioning

confidence: 99%

A Just Assemblage in Mental Health Services—the Necessity of and Possibilities for Service Diversity

Sundet

2021

Front. Psychol.

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Basic to the Norwegian welfare state is the principle of universality; every citizen has the right to equal health care and social services. Experiences from a family team in mental health care for children and adolescents exemplify challenges for mental health work in this welfare state. These experiences indicate an ongoing process of dismantling the welfare state, disguised as managerial changes and reorganizations. The argument is put forth that these changes and reorganizations that are claimed to benefit service users actually have negative consequences for many of them. These negative consequences are related to how psychological research on and knowledge of mental health and treatment are combined with organizational principles. The concept of an assemblage is introduced as a manner of describing the dominating relationships in health care between the medical model, the randomized controlled trial and new public management in order to provide responsible health care practices. Rooted in a supposition that how we look upon, describe and understand causation defines our views of science in general, how to produce knowledge, what kind of scientific knowledge is most productive, and how it should be implemented in practice, an alternative assemblage is suggested that better realizes the principle of universality. Here justice is about equal opportunities and equal rights to treatments and sets of practices that fit people as unique individuals. Such an assemblage would bring together diverse models of mental health care, a network of multiple research-based knowledges, and service organizations that include the differences and diversity of the population.

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Dispositions and the Unique Patient

Cited by 2 publications

References 13 publications

How precision medicine changes medical epistemology: A formative case from Norway

How precision medicine changes medical epistemology: A formative case from Norway

A Just Assemblage in Mental Health Services—the Necessity of and Possibilities for Service Diversity

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