UK Arts and Humanities Research Council project 2012

Brendan Clarke, Donald Gillies, Phyllis Illari, Federica Russo, Jon Williamson

Evidence-based medicine is a relatively recent technique for supporting clinical decisions by the ‘conscientious, explicit, and judicious use of current best evidence’ (Sackett et al. 1996. BMJ. 312: 71). This ‘best evidence’ usually has a very specific meaning: the best evidence available to support decision-making in medicine is that arising from clinical trials, where treatments are tested on large numbers of patients. On the other hand, evidence of mechanisms – usually characterized as knowledge gained from experimental investigations in the laboratory – is held to be of low quality by the EBM practitioner.

However, recent work in the philosophy of causality has suggested that this hierarchical interpretation of evidence is problematic, while even within medicine there is interest in evidence that can complement evidence gained in clinical trials.

Decisions about treatment make a difference to the health of individuals. Therefore it is of utmost importance to develop a concept of evidence that maximizes the available sources of evidence (trials, results of lab experiments) and minimizes the risks of errors in various medical decisions.

In this project, we aim to investigate the relationship between evidence-based medicine, evidence of mechanisms, and causality from a number of different theoretical and practical perspectives including philosophy of causality, philosophy and history of medicine, and medical practice.