Need scientists worry about philosophy? Or should philosophers get off their backs and let them do their work in peace? Unsurprisingly, many scientists want to stay clear of philosophical discussions. What is more disturbing is when I hear philosophers themselves announce that our discipline has nothing useful to offer science. In my view, they could not be more wrong.
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. Continue reading
There is a philosophical problem within medicine: how to deal with causal complexity and variations. While existing methods are designed for large scale population data and sufficiently homogenous sub-groups, a number of medical conditions are characterised by their heterogenic and complex nature: low back pain (LBP), chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), tension-type headache (TTH), post-traumatic stress disorder (PTSD), and many others. Continue reading
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. Continue reading
Often we behave as if we think that a cause can only have one effect, while in fact it can have many. The type of effect depends on what else there is, besides the cause. In other words, it’s a matter of context. Continue reading
Not everyone thinks we need causation in science. Causation is so hard to pin down and so easy to get wrong, so why don’t we instead just stick to the data? Without speculating over causal relationships we could then establish that people are happier without children, that married men live longer and that life expectancy for smokers is ten years shorter than for non-smokers. What more do we need to know? Continue reading