Evidence-Based or Person-Centered? An Ontological Debate

In a recent paper published in European Journal for Person Centered Healthcare, I argue that the choice between EBM and person centered healthcare is a choice between conflicting ontologies, involving two very different notions of causation. While the methodology and practice of EBM seems perfectly supported by positivism and a Humean theory of causation, person centered healthcare does not. There is, however, a trend called the EBM Renaissance Movement, attempting to make EBM more person centered. In the CauseHealth project, we urge that person centered healthcare and practice requires a very different ontology and methodology from the positivist scientific ideal inspired by David Hume.

How safe is a condom?

On Friends, Rachel becomes pregnant with Ross in spite of using a condom. It comes as a shock to all when they hear that condoms are only 97 percent effective. Or, as Rachel puts it, condoms only work 97 percent of the time. But what does this really mean?

What RCTs can’t do

Establishing causation is not an easy task and a number of scientific methods have been developed specially for this purpose. Randomised controlled trials (RCTs) are by many, but not all, considered to be the gold standard. This means that RCTs are thought to provide the highest form of evidence of causation, and the results of such studies are frequently used to guide expert advice on what to eat, how to teach, which medical treatment to choose, whether to worry about pesticides, and so on. But can we trust RCTs to tell us the full causal story? Not really.

How to interpret statistical data?

Causation is sometimes treated probabilistically. Rather than committing a 100 percent to the effect in our causal predictions, we might say that there is a certain chance of the effect occurring, given the cause. But what do we mean by this? It depends. First, it depends on what we take causation to be. Second, it depends on what we take probability to be.