Uncategorized – Causality, Complexity and Evidence in Health Sciences

Bringing the patient’s perspectives forward in drug development and healthcare evaluation

By Keith Meadows and Matt Reaney

For many years psychologists and other social scientists have been pushing for the individual patient’s perspective – priorities, needs, feelings and functioning – to be incorporated into drug development. This is usually achieved through the use of patient-reported outcome measures (PROMs) in clinical trials. The development and use of PROMs situates them at the vertex of two very different trends in medicine: patient-centred care and standardization. Indeed the application of PROMs – which pull in the direction of standardisation – results in a narrow conception of evidence by overriding the subjectivity of individual experiences, beliefs and judgments. Without additional context, PROM data cannot easily support individual patient-level care. When collected systematically and with an interpretive phenomenological approach, narrative data can contain valuable information about the patient experience that numerical ratings from PRO measures do not capture.

Causal insights from failure. What pharmacovigilance can teach us about causality

It is the business of pharmacovigilance to evidence causal failure: when the effects of the drugs are unexpected. Simply knowing that a medicine can affect or interact with a particular biological mechanism is itself a valuable piece of causal information, argue Elena Rocca, Rani Lill Anjum and Stephen Mumford in a recent publication. Read more about this and the CauseHealth collaboration with Uppsala Monitoring Centre (UMC) in Uppsala Reports.

CauseHealth Risk and Safety in the magazine for global pharmacovigilance updates ‘Uppsala Reports’

CauseHealth Risk and Safety

The magazine Uppsala Reports, which disseminates globally the updates from UMC and the WHO Programme for International Drug Monitoring since 1996, has dedicated the cover of its 82nd issue to our project, CauseHealth Risk and Safety.

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What’s in a word? It’s all Biopsychosocial, and a part of the complex human “ecosystem”

by David Poulter

There is still a lot of confusion regarding the word “biopsychosocial”. Yes it’s a compound word made up of three other words Biological (physical), Psychological (of the mind) and Social (of the environment). The trouble is that just like the word biopsychosocial is all one, so are humans.

Causality in Psychotherapy Research

Dr Hanne Oddli, Associate Professor at the Department of Psychology, University of Oslo, is a clinical psychologist, and researcher. In this video she presents the ongoing work promoting evidential pluralism in psychotherapy research based on a dispositionalist understanding of causality.

Open access CauseHealth resource for clinicians

A multidisciplinary book dealing with the philosophical biases that tacitly motivate evidence based and person centered clinical practice.

Short presentation video

Access and download the book for free on the Springer webpage.

Long presentation video

CauseHealth and the clinic. Philosophical bias in medicine

1280px-Lotyšské_etnografické_muzeum_v_přírodě_(91) — Any science is built on assumptions that are non-empirical, and rarely debated.

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. Continue reading “CauseHealth and the clinic. Philosophical bias in medicine”

A philosophical conundrum at the heart of the cranial debate: as explained by Professor Stephen Tyreman

osteofm

A reminder of the great mind and gentle humanity of Stephen Tyreman. I was honoured to be sent this to publish on the blog, and hope that through writings such as this, he can continue to enlighten and inform us. He wrote it in response to a piece by Monica Noy on “cognitive dissonance”.

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Cranial Concept, Reality and Perception

Thanks Monica for this honest and thought-provoking piece and also to Penny for drawing my attention to Monica’s thoughts. It takes a lot of courage to speak out against the prevailing assumptions, practices and mores of any group and particularly of osteopathy which continues to be defensive and therefore somewhat ‘touchy’ about its identity and status in respect to other parts of healthcare.

I suppose I’m a bit closer to Penny’s view on the cranial concept, which is that while the theoretical ‘foundation’ of cranial work is very suspect with…

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CAUSAL DISPOSITIONS IN RISK ANALYSIS

Capture 3 Technology should make our life better, easier and safer. And yet, medicines, pesticides, nanotechnologies, biotechnologies et cetera, may represent a potential threat to health and environment. Some of the new technologies might be safe for most, but they could still be harmful for vulnerable individuals, communities or ecosystems. Continue reading “CAUSAL DISPOSITIONS IN RISK ANALYSIS”

Managing Complexity In Musculoskeletal Conditions: Reflections From A Physiotherapist

In this blog (and linked article), physiotherapist Matt Low explains how he uses patient narratives, mind-maps and the vector model of causation to help his patients. The result is a person-centered approach that emphasises causal complexity, individual context and the idea that at least some of the causes of pain can be counteracted and thus controlled by the patient. Matt is a collaborator of CauseHealth and this is his second article describing his unique approach to chronic pain.

Perspectives on Physiotherapy

I was fortunate enough to have been invited by Physio First to contribute to their journal ‘In Touch’ and I chose to write about managing complexity with the different types of ‘evidence’ that we deal with in a healthcare setting.

This is an area of interest for me and I still grapple with many areas of clinical practice. These include balancing the normative and narrative examination, evaluating and weighting the evidence appropriately for the person seeking care in front of me and also reconciling and communicating the reasoning process within a person centred framework. Clearly, this is work in progress and I hope this reflective piece demonstrates a movement in this direction.

I hope this paper is informative and useful in that it shares some of my deliberations, thoughts and perspectives in clinical care.

Many thanks to Physio First http://www.physiofirst.org.uk/ for giving me the opportunity to share this.

Managing complexity…

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