Abstract
Since the introduction of evidence-based medicine, there have been discussions about the epistemic primacy of randomised controlled trials (RCTs) for establishing causality in medicine and public health. A growing movement within philosophy of science calls instead for evidential pluralism: that we need more than one single method to investigate health outcomes. How should such evidential pluralism look in practice? How useful are the various methods available for causal inquiry? Further, how should different types of causal evidence be evaluated? This paper proposes a constructive answer and introduces a framework aimed at supporting scientists in developing appropriate methodological approaches for exploring causality. We start from the philosophical tradition that highlights intrinsic properties (dispositions, causal powers or capacities) as essential features of causality. This abstract idea has wide methodological implications. The paper explains how different methods, such as lab experiments, case studies, N-of-1 trials, case control studies, cohort studies, RCTs and patient narratives, all have some strengths and some limitations for picking out intrinsic causal properties. We explain why considering philosophy of causality is crucial for evaluating causality in the health sciences. In our proposal, we combine the various methods in a temporal process, which could then take us from an observed phenomenon (e.g., a correlation) to a causal hypothesis and, finally, to improved theoretical knowledge.
Highlights
The current evidence-based paradigm requires that the most reliable scientific evidence is used to increase patient safety by predicting how a certain intervention might affect health and well-being.This is true both in a strictly clinical context, where doctors and patients need to evaluate the potentiality of interventions for the single case, and in public health, where policy interventions are needed at the population level
There has been some discussions about the epistemic primacy of statistical approaches, such as randomised controlled trials (RCTs), for establishing causality and predict the health outcomes of medical interventions
This article has received considerable attention, partially because it is written within a growing movement that calls for evidential pluralism in the medical and health sciences [2,3,4,5,6,7]
Summary
The current evidence-based paradigm requires that the most reliable scientific evidence is used to increase patient safety by predicting how a certain intervention might affect health and well-being. Scholars who argue that we need plural methods to establish causality use different types of arguments and have different emphasis Some traditions, such as critical realism, are primarily critical of the ontological bias in scientific methodology; they argue that standard ways to evaluate causal evidence mistakenly rely on a positivist, Humean conception of the nature of causality [2,8,9]. We propose our own version of evidential pluralism This version is based on the philosophical idea that any type of scientific claim, including causal claims within medicine and public health, should seek to say something about a system’s intrinsic properties, as well as their mutual influence and causal interaction. This is relevant for ensuring that all the evidence necessary for the safe treatment of individuals and populations is considered
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