Evidence and causal knowledge: what is the relationship between evidence-based medicine and science-based medicine?

[S. Jevtić]

318 str.

Filozofija - Filozofija medicine / Philosophy - Philosophy of medicine

ovoj disertaciji upoređujemo dve medicinske paradigme – medicinu zasnovanu na dokazima i naučnu medicinu. Distinkcija između ovih dveju paradigmi određena je prvenstveno s obzirom na preovlađujući statistički pristup i tip svedočanstva koji ih odlikuje, a u najširem smislu s obzirom na način na koji hipoteze o uzročnosti u njihovim okvirima bivaju testirane. Dok medicinu zasnovanu na dokazima karakteriše frekventističko testiranje hipoteza i dominantno oslanjanje na svedočanstvo o razlici, naučnu medicinu odlikuje bajesovsko testiranje hipoteza i evidencioni pluralizam, to jest pozivanje i na svedočanstvo o razlici i na svedočanstvo o mehanizmima. Nastojimo da pokažemo da evidencioni pluralizam karakterističan za naučnu medicinu omogućava veću internu i eksternu validnost zaključaka o uzročnosti u odnosu na medicinu zasnovanu na dokazima, što, smatramo, ima praktične implikacije u vidu plodonosnijeg odnosa i većeg stepena realizacije osnovnih komponenti medicinske prakse koje su koncipirali utemeljivači medicine zasnovane na dokazima. Potom preispitujemo kako se distinkcija između medicine zasnovane na dokazima i naučne medicine odražava na konceptualno i ontološko poimanje uzročnosti. Primarno pitanje je koji pojam uzročnosti leži u osnovi evidencionog pluralizma koji odlikuje naučnu medicinu i kakva je ontološka priroda ove uzročnosti. Tvrdimo da u osnovi naučne medicine leži kako konceptualno tako i ontološki monistički shvaćena uzročnost, odnosno da je evidencioni pluralizam kompatibilan sa uzročnim monizmom. Zato je moguće monističko poimanje uzročnosti koje ima izvesne prednosti u odnosu na popularni konceptualni i ontološki uzročni pluralizam.

In this dissertation, we compare two medical paradigms – evidence-based medicine and science-based medicine. e distinction between these two paradigms is determined primarily with regard to the prevailing statistical approach and the type of evidence that characterizes them, and in the broadest sense with regard to the way in which causal hypotheses are tested within their frameworks. While evidence-based medicine is characterized by frequentist hypothesis testing and a dominant reliance on evidence of difference-making, science-based medicine is characterized by Bayesian hypothesis testing and evidential pluralism, that is, appealing to both evidence of difference-making and evidence of mechanisms. We seek to show that the evidential pluralism that characterizes science-based medicine allows for greater internal and external validity of causal inferences than evidence-based medicine, which, we believe, has practical implications in the form of a more fruitful relationship and a greater degree of realization of the basic components of medical practice conceived by the founders of evidence-based medicine. We then review how the distinction between evidence-based medicine and science-based medicine reflects on conceptual and ontological understandings of causation. e primary question is what concept of causation underlies the evidential pluralism that characterizes science-based medicine and what is the ontological nature of this causality. We claim that both conceptual and ontological causal monism underlies science-based medicine, that is, that evidential pluralism is compatible with causal monism. erefore, a monistic understanding of causation is possible, which has certain advantages over the popular conceptual and ontological causal pluralism

medicina zasnovana na dokazima, naučna medicina, frekventizam, bajesijanizam, svedočanstvo, uzročnost, evidencioni pluralizam, uzročni monizam, Ruso-Vilijamson teza, epistemička teorija uzročnosti

evidence-based medicine, science-based medicine, frequentism, Bayesianism, evidence, causality, evidential pluralism, causal monism, Russo-Williamson thesis, epistemic theory of causality

1:[001:61(043.3)

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