The Guidelines Challenge: Philosophy, Practice, Policy

October 3-4, 2017, Oxford, England at the Oxford Spires Hotel

Trish Greenhalgh is one of the keynote speakers

Audio recordings of the talks are now on YouTube! Link here…

Keynote Speakers:
Brian Broom
Nancy Cartwright
Trish Greenhalgh
Mike Kelly

CauseHealth takes on the challenges related to causal complexity, individual variations and external validity in health sciences. Guidelines, for various reasons, are often used more rigidly in clinical settings than the developers intended. But one size does not fit all. Evidence from the patient context can be more causally relevant in deciding treatment than what has been shown to work at the group level.

This conference brings together practitioners, guidelines networks and philosophers of science to address the general problem of how to put the tools of philosophy to use in improving the development and implementation of healthcare guidelines.

In particular, how do we reconcile the purpose of guidelines with the needs of the clinic? There is a growing movement towards the particular (e.g. person centred approaches, individualised treatments, incorporating patient narratives and clinical judgement), while guidelines must be general (e.g. providing evidence-based advice and methods for clinical decision-making).

Specific topics include questions about how guidelines should meet the challenges of:

  • Multi-morbidity
  • Individual variation
  • Complex illnesses
  • Multiple diagnoses from common symptoms
  • Investigating the mechanisms underlying the onset of illnesses
  • Amalgamating evidence from the medical literature with patient’s narrative
  • Moving beyond the empirical ideal of value neutrality in medical research
  • Integrating a whole-person, patient-centered view in evidence-based health care
  • Finding the space for experts and patients ‘implicit knowledge’

We aim to reach a wide, interdisciplinary audience of medical researchers, practitioners, guideline developers, philosophers of medicine, communicators and patients.

Expected learning outcomes include:

critical perspectives about the evaluation of evidence in medicine;
– insights on the amalgamation of different types of evidence;
– insights on the type and quality of evidence regarding biological mechanisms;
– important background considerations for designing of clinical experiments;
– critical considerations about the boundaries between value judgements and empiricism in medicine;
– important background considerations for clinical use of guidelines.




9:30-9:45 Rani Lill Anjum, Welcome and Introduction

9:45-10:45 Trish Greenhalgh, Desperately Seeking Personalisation: How Evidence-Based Guidelines Sometimes Produce Non-Evidence-Based Care

10:45-11:00 Coffee Break

11:00-12:30 Session 1: Challenges in Development – Integrating Knowledge through Collaboration

Beth Shaw & Sietse Wieringa, Appraising and Including Different Knowledge in Guidelines – GIN AID Knowledge Working Group

Mike Kelly, Empiricism, Reductionism, Linearity and Value Neutrality in Guideline Development: A Realist Alternative

12:30-1:30 Lunch at The Spires

1:30-2:30 Session 2: The Challenge of Implicit Knowledge I

Elizabeth Matovinovic, From Implicit Knowledge to Explicit Guidelines (a GRADE perspective)

Karin Engebretsen, Suffering Without a Medical Diagnosis

2:30-2:45 Coffee Break

2:45-3:45 Session 3: The Challenge of Evidence – Considering Mechanisms

Sarah Wieten, Manageable Mechanisms: How Confounders Make Amalgamation Difficult

Elena Rocca, Evaluating Evidence of Mechanism

3:45-4:00 Coffee Break

4:00-5:30 Session 4: Challenges in Practice I – Keeping the Person Whole

Anna Luisa Kirkengen, From Wholes to Fragments to Wholes — Is Something Lost in Translation?

Brian Broom, Getting Real in Whole Person-Centred Healthcare: The Challenges in Actually Doing This Stuff



9:00-10:00 Nancy Cartwright, What Evidence Should Guidelines Take Note Of?

10:00-10:15 Coffee Break

10:15-11:15 Session 5: Challenges in Practice II – Where do the Values Come in?

Minna Johansson, ‘Informed Choice’ – No Panacea for Ethical Difficulties

Stephen Tyreman & Bill Fulford, Choosing Together: From Informed Choice to Dialogue

11:15-11:30 Coffee Break

11:30-12:30 Session 6:  The Challenge of Implicit Knowledge II

Fiona Moffatt, The New ‘Normal’? Professional Sense-making and Evidence Based Guidelines

Mat Mercuri, When Guidelines Don’t Guide: Examining the Role of Patient Context in Guideline Adherence

12:30-1:30 Lunch at The Spires

1:30-2:30 Session 7: The Guidelines Challenge I – Using Guidelines

Samantha Copeland, Effectual Reasoning in the Clinical Context

Alex Broadbent, Judges or Robots? Medical Expertise in the Guideline Era

2:30-2:45 Coffee Break

2:45-3:45 Session 8: The Guidelines Challenge II – What’s in a Guideline?

Hálfdán Pétursson, The Validity and Relevance of Guidelines for Prevention of Cardiovascular Disease for General Practice

Stephen Mumford & Rani Lill Anjum, A Philosophical Argument Against Evidence-based Policy

3:45-4:00 Short Break

4:00-5:00 Session 9: Meeting the Guidelines Challenge – Round-up and Deliverables
Roger Kerry (plus panel)

5:00 End



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A CauseHealth event, with co-sponsor Trinity 

Image By Niki Odolphie from Frome, England (Longleat Maze) [CC BY 2.0 (, via Wikimedia Commons
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