Rethinking bias and truth in evidence‐based health care

Abstract

In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence‐based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of “bias.” To prevent unwarranted relativism and make better inferences in clinical practice, clinicians may benefit from a closer analysis of existing assumptions about truth, validity, and reality.In this paper, we give a brief overview of several important theories of truth, notably the ideal limit theorem (which assumes an ultimate and absolute truth towards which scientific inquiry progresses), the dominant way truth is conceptualized in the discourse and practice of EBHC.We draw on Belgian philosopher Isabelle Stengers' work to demonstrate that bias means one thing if one assumes a world of hard facts “out there,” waiting to be collected. It means something different if one takes a critical view of the knowledge‐power complex in research trials. Bias appears to have both an unproductive aspect and a productive aspect as argued by Stengers and others: Facts are not absolute but result from an interest, or interesse: a bias towards a certain line of questioning that cannot be eliminated.The duality that Stengers' view invokes draws attention to and challenges the assumptions underlying the ideal limit theory of truth in several ways. Most importantly, it casts doubt on the ideal limit theory as it applies to the single case scenario of the clinical encounter, the cornerstone of EBHC. To the extent that the goal of EBHC is to support inferencing in the clinical encounter, then the ideal limit as the sole concept of truth appears to be conceptually insufficient. We contend that EBHC could usefully incorporate a more pluralist understanding of truth and bias and provide an example how this would work out in a clinical scenario.

Mismatches in the production of a scoping review: Highlighting the interplay of (in)formalities

“…Literature reviews within evidence‐basing is a paradigmatic example of a product shaped by formal rules . The formal rules serve to minimize the influence of personal biases when searching, mapping, and synthesizing scientific studies . Empirical studies of the production of knowledge within STS and other fields, however, have shown that formalized methods help create a canonical view of general and objective scientific knowledge although the actual practices of science are highly particular and informal .…”

“…In these recent developments of scoping review methods, the attempts to avoid bias using formal rules assume that individual judgments can be done away with and that the presence of individual judgments would compromise the truth that formal rules aim to establish . However, according to research within STS, formalities do not oppose informal expertise, but they exist in a dynamic and creative interplay .…”

Social determinants of unhealthy lifestyles

“…I tried to put Godlee’s article into context because questions arise such as, “What put me in need of drug treatment?” and “Why is this need non-randomly distributed?” I hope we can rethink bias and truth in evidence based healthcare5 and focus our time on other words that start with E 6…”

Interactions between persons—Knowledge, decision making, and the co‐production of practice

“…As reported in the most recent philosophy thematic edition of this journal, researchers are rising to this challenge, to develop accounts of these key ideas with substantive import and application. To do so effectively requires not only extensive empirical work to understand and adequately characterize perspectives previously ignored or marginalized but also a fundamental conceptual shift in our understanding of the nature of and relationships between knowledge, evidence, value, patient experience, and the social context of care, as well as the social context of research and all forms of knowledge production . Put in economic terms, this shift requires a movement away from construing care as something provided to patients by professionals and towards a model of partnership or co‐production: “the design, delivery and evaluation of services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours.”…”