A seminar at NMBU invited a group of clinicians from around Norway to discuss philosophical biases in medicine with us and each other. We discussed the challenge of pursuing genuine person centered healthcare for individual patient in a system of New Public Management, standardisation and silo medicine. The invited participants had backgrounds from psychology, nursing, general practice, psychiatry, physiotherapy, osteopathy, rehabilitation, speech language pathology, and more.
Common for all, was the need to think critically about the philosophical foundation of medicine. Specifically, the participants agreed that identifying conflicting philosophical biases underlying person centered healthcare and evidence based practice is a crucial tool to discuss professional disagreements in a meaningful way.
What falls under the notion of ‘evidence’ will be decided by the existing paradigm: theories, methods, research questions, what counts as data and what counts as results. The problem is then that any criticism against the paradigm can be dismissed as unscientific, since it necessarily aims to push science beyond its own paradigm.
If one criticises evidence based practice or evidence based medicine, therefore, in a way that challenges current conceptions, one might be misunderstood as being ‘against scientific evidence’. But that would be a mistake. As should be clear from the open letter to BMJ EBM, ‘Medical scientists and philosophers worldwide appeal to EBM to expand the notion of ‘evidence’’, the question of controversy is what should count as causally relevant evidence. The letter is signed by 42 clinicians and philosophers of causation, urging that EBM moves beyond the numbers and acknowledges the importance of other types of causal evidence, including questions of ‘how’ and intervention works, and for whom, not only what proportion of patients achieved the intended result.
The job of CauseHealth is to identify and critically discuss some deeper, non-empirical assumptions that tacitly motivate evidence based approaches: empiricism, frequentism, determinism, mereological composition, mono-causality, dualism, reductionism, and so on. Such philosophical biases can all be detected in the norms, methodology and practices in EBM and EBP, paired with a need for top-down control and standardisation of care.
Ultimately, CauseHealth is part of a global, transdisciplinary effort to push the paradigm of EBM and EBP out of the positivist era and into a genuine person centered healthcare where the clinical needs come first and one size is not expected to fit all patients.