The guidelines challenge—<scp>P</scp>hilosophy, practice, policy

Anjum, Rani Lill; Copeland, Samantha; Kerry, Roger; Rocca, Elena

doi:10.1111/jep.13004

Cited by 8 publications

(6 citation statements)

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“…Russo and Williamson (2007) also argue that mechanistic knowledge is needed to plan the experimental design of clinical trials, as well as for the interpretation of the results from such studies. Rocca (2018) adds to these that knowledge of the causal mechanisms underlying medical phenomena is necessary to evaluate complex evidence, and to judge which population study we need to trust when different studies give conflicting results. Gillies (2018) argues that mechanistic knowledge is needed, not only to establish causal hypotheses about the cause of illness, but also to develop an appropriate treatment and for evaluating the safety of a treatment.…”

Section: Simply Put…mentioning

confidence: 99%

Rethinking Causality, Complexity and Evidence for the Unique Patient

Maretic¹

2022

Osteopathische Medizin

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Section: Simply Put…mentioning

confidence: 99%

Rethinking Causality, Complexity and Evidence for the Unique Patient

Maretic¹

2022

Osteopathische Medizin

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“…One thing is that listening to patient narratives is considered essential to understand their needs and values [39]. Another point, more relevant for causal inquiry, is that patients can provide essential elements of the causal story, through the subjective narration of their experience [40,41]. By listening to the story that a patient tells, and to the way in which she chooses to tell it, one can map detailed contextual information that could contribute to explaining the patient's current condition.…”

Section: Patient Narrativementioning

confidence: 99%

Causal Evidence and Dispositions in Medicine and Public Health

Rocca

Anjum

2020

IJERPH

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Since the introduction of evidence-based medicine, there have been discussions about the epistemic primacy of randomised controlled trials (RCTs) for establishing causality in medicine and public health. A growing movement within philosophy of science calls instead for evidential pluralism: that we need more than one single method to investigate health outcomes. How should such evidential pluralism look in practice? How useful are the various methods available for causal inquiry? Further, how should different types of causal evidence be evaluated? This paper proposes a constructive answer and introduces a framework aimed at supporting scientists in developing appropriate methodological approaches for exploring causality. We start from the philosophical tradition that highlights intrinsic properties (dispositions, causal powers or capacities) as essential features of causality. This abstract idea has wide methodological implications. The paper explains how different methods, such as lab experiments, case studies, N-of-1 trials, case control studies, cohort studies, RCTs and patient narratives, all have some strengths and some limitations for picking out intrinsic causal properties. We explain why considering philosophy of causality is crucial for evaluating causality in the health sciences. In our proposal, we combine the various methods in a temporal process, which could then take us from an observed phenomenon (e.g., a correlation) to a causal hypothesis and, finally, to improved theoretical knowledge.

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“…Another example of this was given at the Guidelines Challenge Cause Health conference by speaker Hálfdán Pétursson (Pétursson et al 2009; for a review of talks at that conference, see Anjum et al 2018). He discussed the problems encountered by general practitioners (GPs) who are trying to follow the guidelines for preventing cardiovascular disease in Norway.…”

Section: Guidelines and Evidence Based Policymentioning

confidence: 99%

The Guidelines Challenge

Copeland

2020

Rethinking Causality, Complexity and Evidence for the Unique Patient

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This chapter looks at one of the key problems experienced by practitioners of medicine today, especially in large or public institutions, which is how to handle guidelines. Public management approaches to medicine tend to promote guidelines as rules to follow, and clinicians often feel pressure to follow a guideline even when their judgment cautions them to do otherwise. This ‘tramline’ approach to guidelines, we show, is philosophically as well as practically problematic. Especially when we take dispositions as the ontology of the causal relations that guidelines want to key in on—the best way to cause a recovery, or to counteract the causes of a condition—we see that guidelines cannot and ought not be treated as rules to be followed. We thus also make suggestions in this chapter about what kinds of guidelines, in terms of form and function, might be ideal.

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The guidelines challenge—Philosophy, practice, policy

Cited by 8 publications

References 20 publications

Rethinking Causality, Complexity and Evidence for the Unique Patient

Rethinking Causality, Complexity and Evidence for the Unique Patient

Causal Evidence and Dispositions in Medicine and Public Health

The Guidelines Challenge

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