tailieunhanh - Centre for Philosophy of Natural and Social Science Causality: Metaphysics and Methods

The regular course was taken for two purposes: to allow him the right to practice unmolested, and, as he declared, that he might the more clearly “detect errors of the modern practice.” Armed with the certificate of right to practice and of good moral character, he set out to follow his chosen art, but not in the regular way. He leaned strongly toward the use of vegetable medicines as against what were then termed mineral medicines. In order to pursue his calling and also to spread abroad his views and practice, he opened a clinical school known as the United. | CPNSS Centre for Philosophy of Natural and Social Science Causality Metaphysics and Methods Technical Report 01 03 What Evidence in Evidence-Based Medicine John Worrall Editor Julian Reiss What Evidence in Evidence-Based Medicine John Worrall Department of Philosophy Logic and Scientific Method London School of Economics Houghton Street London WC2A 2AE England September 2002 I am indebted to Brian Haynes and Ken Schaffner for comments and discussion. Haynes is one of the leaders of the EBM program worldwide. I am especially indebted to Dr Jennifer Worrall for extensive discussions of the issues raised in this paper. Unlike myself Dr Worrall has first hand experience both of clinical trials and of the problems of trying to practice medicine in an evidence-based way and hence her contributions to this paper have been invaluable. Finally I am also greatly indebted to my former colleague Dr Peter Urbach who first brought me to question the orthdoxy on the randomization issue see for example his 1993 whose arguments against the necessity for randomization form the starting point for my treatment and who supplied me with a number of references. 1 Abstract Evidence-Based Medicine is a relatively new movement that seeks to put clinical medicine on a firmer scientific footing. I take it as un-controversial that medical practice should be based on best evidence -the interesting questions concern the details. This paper tries to move towards a coherent and unified account of best evidence in medicine by in particular exploring the EBM position on RCTs randomised controlled trials in assessing causal claims from clinical medicine especially of course concerning the efficacy of various drug therapies . I argue that even the qualified endorsement of RCTs that a more detailed and sympathetic reading of the EBM literature provides is not clearly based on solid epistemological grounds. I do this by examining four arguments that have been given that claim to show the special .