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Title
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Evidence for causal claims in medicine and the mental health sciences
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Author
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Abstract
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| This dissertation explores current debates concerning the evidence used to establish causal claims, with a particular focus on claims made in medicine and the mental health sciences. It consists of three parts: First, I provide an analysis of the use of evidence hierarchies within evidence-based medicine (EBM). I focus on two kinds of systems for evaluating evidence – systematic ranking schemes like the OCEBM’s Levels of Evidence and GRADE, and Sir Austin Bradford Hill’s informal ‘characteristics’ for demonstrating causation – and weigh the relative merits of each. I also analyze the debate over EBM’s preference for randomized trials. I discuss the major arguments against the primacy of randomization, but ultimately, I argue that, while randomized trials are far from perfect, they nevertheless generally deserve their place at the top of evidence hierarchies. Finally, I move from the theoretical underpinnings of EBM to actual practice. I discuss one area of research in which the primacy of randomized trials – and the methodology of EBM in general – has been challenged, namely, psychotherapy. I dissect the arguments that have been made against using the EBM model in psychotherapy, demonstrating that they do not hold water. I end by proposing and advocating a piecemeal approach to measuring the effectiveness of psychotherapeutic interventions. Second, I explore the role of mechanistic evidence in establishing causal claims. I analyze the debate over the relative importance of statistical and mechanistic evidence, focusing on the arguments of Federica Russo and Jon Williamson on the one hand and Jeremy Howick on the other. Ultimately, I propose and defend the wRWT, a weakened version of the Russo-Williamson Thesis. Finally, I explore the implications of this debate within the context of psychiatry, using the monoamine hypothesis for depression as a case study to show the importance of mechanistic evidence. Returning to psychotherapy, I argue that the failure of the monoamine hypothesis demonstrates that biomedical explanations for depression should be deemphasized and that our focus should be directed toward furthering the pursuit of a psychosocial understanding of the disorder instead. Third, I move to evaluating the epistemic value of current approaches to evidence amalgamation. I look at two major organizations that perform evidence amalgamation: the Cochrane Collaboration and the International Agency for Research on Cancer (IARC). I ask whether evidence amalgamation in practice should try to satisfy Carnap’s principle of total evidence. Ultimately, I argue that we should not try to satisfy the PTE simpliciter since it is not a rational principle. However, more nuanced, local, and contextualized versions of the PTE can be rational and should be used. |
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Language
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English
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Publication
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Antwerp
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University of Antwerp, Faculty of Arts
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2020
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Volume/pages
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188 p.
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Note
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Leuridan, Bert [Supervisor]
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Full text (publisher's version - intranet only)
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