Uncategorized – Page 2 – Causality, Complexity and Evidence in Health Sciences

Living with complexity and big data. Causal dispositionalim enters pharmacovigilance

Ralph Edwards on dispositionalism in pharmacovigilance

We have seen a lot of interest in the CauseHealth approach and issues during these last years, especially among clinicians who see a need for a more person centered healthcare. Can this be useful also outside the clinic? Yes, according to senior medical advisor at the WHO Uppsala Monitoring Center for Drug Safety, Ralph Edwards. In a recent perspectives article in the UMC report, he argues that dispositionalism can be useful for dealing with complexity, individual variation and the patient’s unique context. Continue reading “Living with complexity and big data. Causal dispositionalim enters pharmacovigilance”

What if…

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Author Anna Luise Kirkengen
(#2 of the Whole Person reflections series)

What if one would weave a text by means of threads coloured by the recent topics of the on-going CauseHealth project. One thread would be causality, and how it is understood and applied in current biomedicine. Another would be ontology in the sense of how a human being and the human body is conceptualised in medicine and how this concept underpins the Western health care systems. A third thread would be methodology, and how the predominant methods for knowledge production, group based, randomised trials often including thousands of patients, might be radically challenged by the concept of N=1. A fourth thread would be stories in the sense of biographies before a person fell ill, and stories in the sense of testimonies of being ill – and how these have been systematically avoided as possible source of contamination in medical knowledge production. A fifth thread would then be knowledge condensates as these have grown both in number and normativity in the shape of clinical guidelines in all medical specialties during the latest years. Together, these threads can form quite different pictures, dependent on the frame applied. Continue reading “What if…”

What is the Guidelines Challenge?

Rani Lill Anjum

CauseHealth recently organised a conference in Oxford called The Guidelines Challenge: Philosophy, Practice, Policy.

For those who missed the event, podcasts of the talks are available on our YouTube channel, and there is also a summary from each of the two days on Storify (day 1, day 2). There is also a Twitter hashtag, #GuidelinesChallenge.
Continue reading “What is the Guidelines Challenge?”

Philosophy of Pharmacology Symposium at ECAP9 (LMU Munich, Aug 2017)

Part of the CauseHealth team went to ECAP9 and spoke about why deep understanding of causation, mechanisms and the local context is essential for drug safety. We were also excited to be in a session with Ralph Edwards, former Director of the Uppsala Monitoring Centre for drug safety, which acts as the official advisor for the World Health Organisation (WHO). Thanks for having us, Barbara!

PhilPharm: Safety, Statistical Standards, and Evidence Amalgamation

The symposium “Philosophy of Pharmacology: Theoretical Foundations, Methodological Evolution, and Public Health Policy” took place at LMU Munich on 22 August, 2017, as part of the Ninth Congress of Analytic Philosophy (ECAP9) of the European Society of Analytic Philosophy (ESAP). The congress was jointly organized by Barbara Osimani, Jürgen Landes, and Roland Poellinger. The program featured contributions by four speakers:

Barbara Osimani (Ancona / LMU)
Rani Lill Anjum (Norwegian University)
Elena Rocca (Norwegian University)
Ralph Edwards (Uppsala Monitoring Centre of the World Health Organization)

At the overlap of philosophy and health science, this symposium offered a panorama of the complex network of interests found in pharmacology (financial, reputational etc.) as well as the scientific and social ecosystem in which pharmacology is embedded. A special focus was on current debates regarding 1) standards for evidence evaluation, 2) methodological evolution, and 3) pragmatics as well as epistemic asymmetry of causal assessment of risk…

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New CauseHealth paper about risk assessment of genetically modified plants

by Elena Rocca

One idea promoted by CauseHealth is that, when evaluating evidence, pre-existing theoretical frameworks count as much as the data. For instance, data from a certain trial assume a particular significance depending on the general background theoretical understanding we have when we interpret them. In this new CauseHealth article, Elena Rocca and Fredrik Andersen show that, when evaluating health risks related to the use of genetically modified plants in agriculture, different ontological starting points play an essential role for the final risk evaluation. Continue reading “New CauseHealth paper about risk assessment of genetically modified plants”

What does CauseHealth mean by N=1?

by Roger Kerry

“N=1” is a slogan used to publicise a core purpose of the CauseHealth project. N=1 refers to a project which is focussed on understanding causally important variables which may exist at an individual level, but which are not necessarily represented or understood through scientific inquiry at a population level. There is an assumption that causal variables are essentially context-sensitive, and as such although population data may by symptomatic of causal association, they do not constitute causation. The project seeks to develop existing scientific methods to try and better understand individual variations. In this sense, N=1 has nothing at all to do with acquiescing to “what the patient wants”, or any other similar fabricated straw-man characterisations of the notion which might emerge during discussions about this notion. Continue reading “What does CauseHealth mean by N=1?”

The Patient: The Beginning of it All

By Elena Rocca

We often think of the perfect medical research and health care system as a system that puts patient’s care as the final aim of a long process. In a way, this is hardly controversial: patient’s interest must be prioritized over commercial interest, for instance. Research hypotheses, funding, experimental designs ought to be developed with a special consideration that they are meant to be primarily useful for the patient. Important steps are being taken in this direction. Continue reading “The Patient: The Beginning of it All”

Evidence synthesis in pharmacology

By Elena Rocca

Pharmacology is a complex science that aims to balance harm and benefit of treatments for the individual patient. How should different types of evidence be synthesised in order to optimize this task? Should evidence from randomized trials be prioritized over other evidence, following the EBM model? If not, how can different types of evidence be amalgamated in an alternative way? Continue reading “Evidence synthesis in pharmacology”

Ethics of Reduction

Karin Engebretsen, Thinking about guidelines:

The question that is still with me after the workshop is how the naturalist paradigm might affect the “political correct” attitude towards patients suffering from medically unexplained syndromes.

If the political decision makers within the medical field believe in the biomedical model as the provider of the best medical practice, their “worldview” will automatically influence the complete medical system.

The biomedical model excludes psychological and social factors and includes only biological factors in an attempt to understand a person’s medical illness or disorder. Thus, the biomedical model has a limited, reductionist attitude that divides the human body into separate elements, focusing on biological factors. Patients often seem to have a unique expression of their symptoms and a unique combination of biological, social and psychological overlapping symptoms. So how do reductionism and dualism affect clinical guidelines and diagnosing related to medically unexplained syndromes?

I see this question as related to ethical issues in medical practice and I hope there will be more focus on this fact as a critical mechanism.

How Decisions are Made

Elena Rocca, Thinking about guidelines:

I was interested in a question that Sietse threw at us many times: what should be the purpose of a guideline? What does “helping to make a good decision” mean?

We got some inputs about it throughout the whole day: it might mean including the patient view, or reporting only the evidence with no recommendation, or giving recommendation but being transparent about which evidence was considered and how it was judged, or again, as Sietse suggested, it might mean to explain what is “to make an inference”, what happens when a clinical decision is made. I was particularly interested in this last suggestion, and I felt it remained a bit “in the air”. Does it mean that we would need a guideline about the decision process? About the implicit and sometimes unaware stand that the clinician takes by valuing one or the other evidence, following the guideline versus personal judgement?