2000 HSS/PSA Program 1 - History of Science Society

PSA Abstracts
thesis, suggested by Kevin Hoover, that causal relations among “concrete”
variables are fundamental.
Brian Haynes McMaster University
What kind of evidence is it that evidence based medicine advocates want
patients, practitioners, policy makers and the public to pay attention to?
Advocates of evidence based medicine (EBM) want health care providers and
consumers to pay attention to the best findings from health care research that
are both valid and ready for clinical application concerning the cause, course,
diagnosis, prevention and treatment of disease. EBM claims that practitioners
can know what are valid and best practices through understanding recently
developed applied research methods (from the second half of the 20th century)
and using this understanding to judge studies published in the medical literature.
In doing so, EBM advocates have proclaimed a new paradigm, that was initially
and provocatively pitted against traditional medicine, in which the key elements
of knowing for clinical purposes are understanding of basic pathophysiologic
mechanisms of disease coupled with clinical experience. This initial conception,
that EBM is attempting to replace traditional medicine, should to be put to
rest: EBM is attempting to augment rather than replace individual clinical
experience (which EBM sees as necessary but insufficient to provide best
care) with newly derived facts from science that are demonstrably by the new
methods of health care research valid and ready for clinical application. These
methods reduce bias and eliminate many possible alternative explanations for
studies intended to provide clear answers about the nature, detection, and
management of health care problems. EBM raises a number of issues that
have come to the attention of philosophers of science, including what constitutes
best evidence, whether EBM has gone soft in trying to accommodate research
designs other than its gold standard of the randomized controlled trial, and
whether its approach to methodology is explicable by disunity of science
advocates, or in need of a major revision to unify its approach. Also of interest
are questions of whether what one learns from groups of patients in relatively
contrived research settings can be applied to individuals in usual clinical
circumstances. Moral philosophers have taken less interest, but it may be that
the ethical issues raised by EBM are even more important, especially dilemmas
in distributive justice and prolonging life into the realm of misery and beyond
the point of senescence.
220