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Evidence evaluation is a core practice of the sciences. In medicine, specifically, the issue has been tackled by developing analytical and conceptual tools such as the evidence hierarchies. The question that lies at the heart of these methods is how to decide what is the best evidence to base our decisions for diagnosis or for treatment upon. Evidence hierarchies aim to rank evidence according to its quality. In many such hierarchies evidence obtained from randomised controlled trials (RCTs) or systematic reviews of a number of RCTs (meta-analyses) occupies top rank, while evidence obtained from expert judgment or from mechanism is relegated to the bottom of the hierarchy.
Evidence hierarchies have attracted large consensus but also criticism. One such criticism has been that these approaches leave out an important element, namely evidence of mechanisms. In this meeting, scholars affiliated to the EBM+ consortium discussed their work in progress with potential interested parties such as scientists and officers based at Academic Medical Centrum (AMC-UvA), Leiden University Medical Centrum (LUMC), and the Dutch Health Institute (ZINL). The workshop focused on how evidence of mechanism may be considered alongside statistical evidence to improve medical practice.
The workshop started with a talk by Jon Williamson (University of Kent). Jon presented the AHRC funded project “Evaluating Evidence in Medicine” and its main research questions.
He argued that there is much use for evidence of mechanism in assessing causality and that, consequently, it should be considered alongside statistical evidence. Next, Michael Wilde (University of Kent) gave a talk on “Evaluating Evidence of Mechanisms in Medicine: A Handbook for Practitioners”. This work in progress authored by various members of the “Evaluating Evidence in Medicine” project should help medical practitioners to assess the quality of evidence of mechanism and determine how to combine it with evidence from statistical trials in a systematic way.
After that Willem Jan Meerding from the Council for Health and Society gave a talk on “The Illusion of Evidence-based Practice”. He drew attention to the fact that current Evidence Based-Medicine has a too narrow focus. He emphasized the importance of considering different types of evidence like evidence of mechanism, correlations and other experience. Patrick Bossuyt (Academic Medical Center) presented joint work with Juanita Heymans (Health Care Institute) on “Collecting Evidence for Reimbursement Decisions”. Patrick recognised the importance of evidence of mechanism in medical practice. However, he also thinks that due to complexity and interdisciplinary, it will be quite challenging to treat evidence of mechanism in a systematic way.
After lunch, Veli-Pekka Parkinnen (University of Kent) presented joint work with Federica Russo (University of Amsterdam) and myself on “Scientific Disagreement and Evidential Pluralism: Lessons from the Studies on Hypercholesterolemia”. He gave an overview of the historical disagreement of cardiologists and epidemiologists on whether high cholesterol causes heart disease. Sophie van Baalen (University of Twente) talked about “Evidence and Judgment: Epistemological responsibility in clinical decision-making”. She also focused on the lower end of the evidence hierarchy—expertise—and considered the role of tacit knowledge in clinical decision-making.
Denny Borsboom’s (University of Amsterdam) talk on “Network Approaches to Psychopathology: Graphical Models, Explanatory Schemes and Statistical Inference”
was quite challenging. Rather than considering psychological diseases, like depression, as latent variables, he considers them to be a bundle of symptoms that affect each other in a network. Mike Kelly (Cambridge University) on “Relational and individual conceptions of the causes of health inequalities” distinguished between individual-level and population-level explanation. He argued for the absolute importance of considering a population level cause as an entity on its own rather than just as an aggregation of individual level causes.
The workshop ended with a round table discussion moderated by Federica Russo about possible future cooperation between participants of the workshop.“The Evaluating evidence in medicine: Whence and Wither” workshop was funded by the Arts and Humanity Research Council (AHRC), the Institute for Logic, Language and Computation at the University of Amsterdam (ILLC) and the Amsterdam School for Cultural Analysis (ASCA).