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Public health, just as any policy‐related field, faces the evergreen problem of turning knowledge into action. Among other problems, there is a clash between the inherent complexity of public health problems and the inevitable push, by decision‐makers and the public, to simplify them. The Covid‐19 pandemic has shown the insufficiencies of our current epistemological, methodological and normative apparatus to handle such crises in a timely manner. Despite this, several authors have been arguing for the importance of engaging global crises such as Covid‐19 in ways that do not oversimplify key dimensions of the issues involved. In this paper, we contribute to this emerging scholarship. Building on existing work in the field of environmental problem‐solving, we propose an integrative approach to navigating complex trade‐offs in public health interventions. Briefly put, we propose that decision making should be informed by an analysis of any given problem from four distinct, but interrelated, lenses: (i) values and valuation, (ii) process and governance, (iii) power and inequalities and (iv) scientific evidence, methods and concepts. This normative framework, we argue, can help with spelling out the complexity of public health problems and with spelling out the rationale behind public health decision making to non‐specialists and the general public. We illustrate our approach using the controversy over wearing face masks in the Covid‐19 pandemic. [ABSTRACT FROM AUTHOR]

The ‘weight of evidence’ in a topic area can be judged by assessing the ‘Signal’ from available research publications and tempering the importance attached by the level of ‘Noise’ (the inverse of methodological quality). This assessment process has validity and reliability and can be applied to the ‘qualitative overview’ stage of systematic reviews. This enables the important themes and areas of relevance to the research question to be identified. Important findings from individual papers may also be identified providing further information which may not be evident from quantitative analysis. The findings from these more qualitative stages of analysis complement, but do not replace, quantitative analysis. [ABSTRACT FROM AUTHOR]

The author is thankful to the editors of the Journal of Experimental Child Psychology (JECP) who replied on the commentaries on her target paper regarding values-based practice. It mentions about the target paper of the author were the she mainly focused on the practical products of values-based practice particularly in mental health. Topics include liberal point of values-based practice, liberal process of values-based practice, and linguistic analytic philosophy.

Abstract: Rationale, aims, and objectives: The aim of this paper is to (1) summarize the challenges with developing evidence for dressing selection in wound care, (2) discuss the limiting influence that the Evidence‐Based Practice movement has had in this field, and (3) discuss the opportunities offered by Dewey's theory of experimentalism as a pragmatic solution to develop a structured body of evidence. Findings: Whilst the number of dressings available on the market continue to proliferate, limited progress has taken place to develop a methodology for dressing evaluation that is relevant to clinical practice. It is proposed that experimentalism can be operationalized with a mixed‐methods approach that may include the following: (1) medical histories and patient's stories; (2) participant observation and informal interviews; (3) a comparative study between a new dressing and standard care; (4) a patient's satisfaction survey; (5) a staff survey; (6) a cost examination; (7) an evaluation of the packaging and procurement route; and finally (8) a clinical meeting to triangulate the data and reach a consensus. Conclusion: Experimentalism offers a framework for the construction of evidence used for dressing selection. Central to this concept is the integration of experience to the data collected. The context of the evaluation has equal weight to the data thus collected. [ABSTRACT FROM AUTHOR]

Evidence‐based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three‐article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings—all of which raises more questions regarding its application to provider‐patient decision making, pedagogy, and policy. [ABSTRACT FROM AUTHOR]

Abstract Evidence-based medicine (EBM) is a concept that has grown to dominate the medical literature over the last decade. EBM has provoked a variety of criticisms, scientific, philosophical and sociological. However, while its basic conclusion – that we should practise EBM – is ethical, there has been limited ethical analysis of EBM. This paper aims to provide an analysis of EBM from an ethical perspective and identify some of EBM's potential ethical implications. Following a description of what constitutes EBM, this paper will identify and assess some of the basic values and epistemological assumptions of EBM that provide support for the moral duty to practise EBM. It will then examine potential ethical implications that could arise from practising EBM, given the challenges that have been made of EBM's assumptions and claims to authority. This paper will conclude by arguing that practitioners could strengthen the ethics of EBM by embracing a broader definition of evidence and including ethical criteria in the critical appraisal of research studies. [ABSTRACT FROM AUTHOR]

Abstract: This paper is an introduction to the conference, The Guidelines Challenge, held in Oxford in October 2017. My aim is to explain our motivation for organising this conference, as part of the research project Causation, Complexity, and Evidence in Health Sciences (CauseHealth). Depending on the professional starting point, the guidelines challenge can be interpreted in a number of ways. Our idea with this conference was to discuss guidelines from 3 overarching perspectives: practice, policy, and philosophy. In particular, we wanted to discuss some of the challenges that face anyone developing and implementing clinical guidelines in the evidence‐based era of medicine. This introduction gives a brief overview of what CauseHealth sees as the guidelines challenge from these perspectives. More attention is given to the philosophical issues with which the CauseHealth project is particularly concerned, although a proper treatment or discussion of these issues naturally falls outside the scope of this introduction. [ABSTRACT FROM AUTHOR]

Objectives This paper seeks to further explore the question of how best to monitor and govern innovative clinical procedures in their earliest phase of development. We examine the potential value of proposed governance frameworks, such as the IDEAL model, and examine the functioning of a novel procedures review committee. Methods The paper draws upon 20 qualitative, semi-structured interviews. Nine interviews were conducted with members of a committee that was established as a means of governing innovative procedures within a large National Health Service Foundation Trust hospital in the UK. Eleven interviews were conducted with health providers involved with the development of a variety of novel clinical procedures. Results Prominent themes from the data include the potential willingness of clinicians to engage with regulatory frameworks for innovative procedures, existing ways in which clinicians and others attempt to ensure patient's safety and manage uncertainty in the context of novel procedures, views on the potential benefits and drawbacks of engaging with a review committee for novel procedures, and the pragmatic considerations and potential unintended consequences that are entailed in the implementation of regulatory requirements for the monitoring of innovative procedures. Conclusions The views of committee members and clinical innovators help us to understand the practical issues of implementing governance structures for novel clinical procedures. The data illustrate those factors that must be taken into account if governance is to support innovation rather than act as an inhibiting factor in the development of new clinical procedures. [ABSTRACT FROM AUTHOR]

The article discusses various papers published within the issue including one by A. Saad on the effectiveness of evidence-based medicine (EBM) and another about the over-emphasis of EBM on the use of quantitative research fundings in clinical practice.

This paper presents the case for seeking to broaden the ‘evidence base’ of medicine and health care by the inclusion of qualitative research findings. In order for qualitative research to make a significant contribution, advocates of this approach must demonstrate its ability to address questions of relevance to practice and proponents of EBM must rethink their ideas as to what may constitute a research question. A definition of qualitative research is provided, highlighting the somewhat different assumptions which underpin this model. The potential contribution of qualitative findings is assessed and the paper examines the ways in which such insights can be utilized. Finally it addresses the question as to how qualitative findings can be incorporated in the ‘evidence base’. [ABSTRACT FROM AUTHOR]

Possibility is one of the most common modalities in reasoning and argumentation. Various kinds of modal concepts have been identified in philosophical and logical discussion of the metaphysics of modality. We focus here on the concept of clinical possibility. A critical analysis of what is intended as clinical possibility has not yet received sufficient examination, although the concept is extensively used in clinical reasoning. We present arguments to emphasize some desirable features associated with the concept of clinical possibility. We argue that almost all clinical possibilities are potentialities, that is, possibilities that may be actualized by effective, appropriate and feasible interventions. However, in some limited cases, even mere possibilities - which may or may not be actualized, since we do not have the required knowledge - may be involved in clinical reasoning, and we present some examples in this paper. We then introduce some basic views on the nature of possibility showing their validity and limitations when applied to the concept of clinical possibility. Lastly, we conjecture that clinical possibility is a normative modality that can be formalized in a multimodal system with epistemic and deontic logical operators. [ABSTRACT FROM AUTHOR]

Person-centred medicine depends on combining best research evidence with the unique values (including the preferences, concerns, needs and wishes) of individual patients and their families. The paper gives a brief introduction to values-based practice as a new approach to incorporating patients' values into clinical decision making alongside best research evidence as derived from evidence-based practice. The role of values-based practice as a partner to evidence-based practice is illustrated through a series of policy, training and service development initiatives in mental health from the UK Department of Health in London. These initiatives have supported person-centred developments in key areas of mental health practice including, (1) the use of involuntary treatment; and (2) a shared approach of assessment. Early moves are underway to extend values-based practice to other areas of health care beyond mental health. Values-based practice offers a new approach to incorporating patients' unique values into clinical decision making that is complementary to evidence-based practice as a resource for person-centred medicine. [ABSTRACT FROM AUTHOR]

Even though the evidence-based medicine ( EBM) movement labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population-level recommendations to individual patients. Thus, even though the evidence-based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of EBM who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms. [ABSTRACT FROM AUTHOR]

Objectives In a qualitative synthesis, primary qualitative studies are integrated to develop a theory or evidence-based interventions. Until now, the strength of the evidence in the primary studies has not been taken into account in the outcome of the qualitative synthesis. In this paper, a method is developed and evaluated to assign weights to the findings of the qualitative studies using both the frequency and the quality of the reported results. Method Seventeen qualitative studies were retrieved in an illustrative example project on children and trauma. Findings were extracted from the primary studies with the use of coding which resulted in 14 themes. The quality of the studies was appraised using both expert judgement and a quality checklist. These outcomes are used to calculate the weights. Results When the outcomes of the checklist appraisal are compared with those of the expert judgement, the effect on the strength of the evidence is virtually always in the same direction. We found that as the frequency with which a concept is studied is low, the strength of the evidence oftentimes decreases even further when using the quality of the results in the weighing process. Conclusions In the end, the outcomes of a critical appraisal affect the weight that is placed on particular studies. The use of a checklist is recommended because of its more distinguishing ability. The method that was developed for assigning weights to the evidence is discussed in light of both the quality appraisal in qualitative research and the objectives of qualitative synthesis. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on ‘evidence’, rather than ‘intuition’. However, EBM's fundamental distinction between quantitative ‘evidence’ and qualitative ‘intuition’ is not self-evident. The meaning of ‘evidence’ is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for ‘evidence’. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of ‘evidence’, the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore ‘auto-deconstructs’ its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no ‘evidentiary’ basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. [ABSTRACT FROM AUTHOR]

Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM; the unknown effectiveness of EBM; the clinician-centric focus of EBM; and the potential of EBM to harm patients. [ABSTRACT FROM AUTHOR]

In the past 14 years, Evidence-Based Medicine (EBM) has enjoyed unprecedented developments and gained widespread acceptance among health professionals. However, should we be content with producing, critically appraising and using the best evidence available for our understanding of health problems and decision making about them? Are our convictions about EBM’s relevance, our conviction and intellectual satisfaction with its mastery and adoption enough? Should we continue pushing forward along this promising path, or should we further diversify the content and scope of EBM? Is EBM the only way to view medicine in the near future? This paper presents some options to choose from in terms of direction and content as well as questions to answer given the current EBM crossroads. More intensive and extensive EBM combined with ‘other features’-based medicines may be the preferred strategy to follow in the future to determine the development, use and evaluation of EBM. Argument-based medicine or Reasoned Medicine is one of the options that can be integrated into the mainstream of medical reasoning and decision making. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives While the science of knowledge translation (KT) has been growing steadily for the past decade in relation to understanding processes and actions which are embedded within clinical practice settings, little is known about how empirical knowledge is used within the medical education system. Despite an increase of research in this domain, we know very little about the contribution of this evidence in the development of medical students into effective physicians. This pilot study aims to: provide a synthesis of the evidence for educational strategies within medical education; explore the perceptions and experiences of faculty in undergraduate (UG) medical education in relation to their use of evidence in their educational practices; and illuminate how medical education evidence is formally integrated into a UG medical curriculum. Method The study will involve three phases. First, a scoping review of the medical education research literature will be undertaken to generate insight into the evidence available for curriculum development, teaching and assessment activities within this domain. Second, a content analysis of undergraduate courses at the University of Toronto will be undertaken to generate an additional insight into the extent that medical education research has been formally integrated into the UG curriculum for medical students at the University. Finally, a purposeful sample of 30-40 medical education leaders from a single large university, selected as it aims to deliver a rigorous research-oriented medical curriculum, will be interviewed to understand how they use the available evidence in their education practices. Discussion This study will lay the grounds to generate initial data into the determinants of knowledge use in a medical education context. In doing so, the findings will also inform the development of a larger, pan-Canadian study at medical schools that will generate a comprehensive account of the processes and challenges related to KT within an educational context. This larger study will also begin to explore the relevance of the Knowledge-to-Action model to a medical education context. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports within the issue on topics including nature of progress in medicine, the role of empirical data in philosophical debate, and the values-based practice.

The article presents the comments of the authors on the issue of philosophy and ethics in medicine and health care. The attitude of medical writers and practitioners to detach philosophy and clinical practice is criticized by the authors, as they believe that philosophy is not an other-worldly entity. On the contrary, they believe that if incorporated properly, it could enhance the field of evidence-based medicine.

In this article, the author discusses aspects of the argument regarding evidence-based medicine (EBM). He mentions that the narrow concept of evidence and naive conception of the relationships between evidence, theory, and practice are the criticism received by the EBM. He also states that EBM is an epistemological system and not a scientific theory which provides a specific relationship between theory, evidence, and knowledge.

The article presents questions and answers related to the debate on the evidence-based medicine. One person asked if the scholarly clinical journals always facilitate medical progress or if they can suppress it. Finally, another person in the art of soft science asked if the evidence-based medicine reasoned medicine or both.

Discusses articles on critical advances in the evaluation and development of clinical care, published in the 'Journal of Evaluation in Clinical Practice'. Articles on evidence-based medicine (EBM); 'Advancing the Evidence-based Healthcare Debate'; 'Recent Progress in Health Services Research'.

AbstractResearch evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients’ records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients’ preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education. [ABSTRACT FROM AUTHOR]

Abstract: Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of “fake facts” and “truth production.” Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values.” Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values,” which we call “factuation.” We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this “factuation” is key to making HTA valuable to both individual decision makers and society as a whole. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 has posed a wide range of urgent questions: about the disease, testing, immunity, treatments, and outcomes. Extreme situations, such as pandemics, call for exceptional measures. However, this threatens the production and application of evidence. Methods: This article applies standard categories in epistemology to analyse the pandemic in terms of four kinds of uncertainty: Risk, Fundamental uncertainty, Ignorance, and Ambiguity. Results: Mapping the uncertainties of the pandemic onto the four types of uncertainty directs evidence production towards specific tasks in order to address the challenges of the pandemic: Eliminating ambiguity, being alert to the unknown, and gathering data to estimate risks are crucial to preserve evidence and save lives. Conclusion: In order to avoid fake facts and to provide sustainable solutions, we need to pay attention to the various kinds of uncertainty. Producing high‐quality evidence is the solution, not the problem. [ABSTRACT FROM AUTHOR]

Making good decisions depends on having accurate information - quickly, and in a form in which it can be readily communicated and acted upon. Two features of medical practice can help: deliberation in groups and the use of scores and grades in evaluation. We study the contributions of these features using a multi-agent computer simulation of groups of physicians. One might expect individual differences in members' grading standards to reduce the capacity of the group to discover the facts on which well-informed decisions depend. Observations of the simulated groups suggest on the contrary that this kind of diversity can in fact be conducive to epistemic performance. Sometimes, it is adopting common standards that may be expected to result in poor decisions. [ABSTRACT FROM AUTHOR]

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing 'biological plausibility' of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. [ABSTRACT FROM AUTHOR]

Background The Users' Guides to the Medical Literature Manual has been a major influence on the teaching and practice of health care globally. Methods The 3rd edition of the multi-authored Manual was reviewed using the principles outlined in Evidence-based Medicine (EBM) texts. One 'clinical scenario' was selected for critical appraisal, as were several chapters; objectivity was enhanced by citing references to support opinions. Results (summary of the appraisal) (1) Strengths: Clinical pearls, too numerous to list. Examples: (i) evidence is never enough to drive clinical decision making; (ii) do not rush to adopt new interventions; and (iii) question efficacy data based only on surrogate markers. (2) Weaknesses: The Manual shares shortcomings of textbooks discussed by Straus et al.: (i) references may not be current, important ones may be excluded and citations may be selective; (ii) often, opinion-based; and (iii) delays between revisions. (3) Notable omissions: Little or no discussion of: (i) important segments of the population: those <18 years of age, >65 years of age and those with multimorbidity; (ii) surgical disciplines; (iii) Greenhalgh et al.'s essay on EBM; (iv) alternate views on the hierarchy of evidence; and (vi) critical thinking. (4) Additional issues: (i) Omission of important references on dabigatran (clinical scenario: chapter 13.1); (ii) authors' advice (Chapter 13.3) to 'bypass the discussion section of published research'; and (iii) the advocacy of pre-appraised sources of evidence and network meta-analysis without warnings about limitations, are critiqued. Conclusion The Manual has several clinical pearls but readers should also be aware of shortcomings. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables. Methods 419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire. Results The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1-16). The most common treatment interventions across the three conditions were advice on posture (reported by 82-94%), advice to stay active (86-92%), and different types of exercise (65-92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29-96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience. Conclusions Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent. [ABSTRACT FROM AUTHOR]

The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R. G. Collingwood (1889-1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re-centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient-centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice. [ABSTRACT FROM AUTHOR]

Introduction There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals. Hypothesis Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. Methods This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc. Results Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence. Conclusions 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally. [ABSTRACT FROM AUTHOR]

Homeopathic medications are used by millions, and hundreds of millions of dollars are spent on these remedies in the USA alone. In the UK, the NHS covers homeopathic treatments. Nonetheless, homeopathy is held in considerable disrepute by much of the medical and scientific community. Many proponents of homeopathy are well aware of these criticisms but remain unimpressed. The differences of opinion run deep, and the debate seems deadlocked. We aim to shed some light on this situation. We briefly recap some of the major arguments on each side, but we try to go further by making explicit an underlying philosophical presupposition. In particular, we will claim that there is an important principle, which has ancient roots going back at least to Occam, some version of which constrains all empirical reasoning. We call this constraint the simplicity principle. We argue that this is not something specific to a scientific paradigm, but that, all of us, including proponents of homeopathy, are themselves deeply committed to the simplicity principle. However, once the simplicity principle is made explicit and applied to homeopathy, allegiance to homeopathy is clearly seen as irrational. The point is not merely the lack of clinical trials supporting homeopathy; rather, belief in the efficacy of homeopathy leaves a mountain of unexplained mysteries, and thereby flies in the face of the simplicity rule that guides the homeopaths' own reasoning and arguments. If nothing else, we hope that defenders of homeopathy will gain a greater understanding of why critics are so deeply reluctant to accept the efficacy of homeopathic interventions – and that this reluctance is not mere stubbornness or artificial allegiance to western medicine. Finally, we also hope thereby to illustrate the usefulness of philosophy in unearthing presuppositions in seemingly deadlocked debates. [ABSTRACT FROM AUTHOR]

I argue that evidence-based medicine (EBM) imposes methodological limits that constrain the practice and study of medicine in unfortunate ways. EBM attempts to rid the study of medicine of the subjectivity of individual judgements, while in fact, any use of any kind of evidence requires judgement. On this basis, I argue that there are compelling reasons to broaden the range of evidence employed in EBM, and in particular, to include both straightforward and evaluative narratives. This would mark a shift from the current focus of EBM on purely quantitative data to the inclusion of qualitative data as well. I conclude by emphasizing that objectivity in medicine must come not from the exclusion of wide swaths of potentially valuable evidence, but from the careful application of our critical practices. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Current evidence suggests that hospital inpatient identification wristbands are not used optimally. Here we report a project by the National Patient Safety Agency (NPSA) to inform guidance development to hospitals regarding wristband specifications. Method A survey assessed (i) the information on wristbands; (ii) the processes of issuing/checking/applying wristbands onto patients; (iii) the types/designs of wristbands (including colour-coding); and (iv) the main problems faced by staff face in relation to wristbanding patients. Results Responses from 166 staff members from 62 hospitals in England and Wales were collected. Information: most participants reported using the patients' first and last names, their date of birth and their local hospital number. The National Health Service (NHS) number, which is a unique identifier for each patient, is used by 37% of the respondents. Issuing process: wristbands are issued on admission or at Emergency Departments. Trained or untrained staff are involved in issuing/checking/applying wristbands onto patients, without significant problems. Colour-coding: 29/36 multiple-respondent hospitals and 15/16 single-respondent hospitals use colour-coded wristbands to indicate special patient status (e.g. allergies). Colour-coding is not used consistently: four colours are used to signal risk of fall; red is used to signal at least 10 different statuses/risks. Conclusion The NPSA recommends that wristbands should include patient's last and first name, date of birth and NHS number. They should be printed/written in black against white background. Only red colour should be used to signal special patient status. These recommendations are consistent with current developments in patient identification, and will be evaluated. [ABSTRACT FROM AUTHOR]

Anecdotal case reports contribute about one-third of the published literature on adverse drug reactions and interactions, but are regarded as providing poor-quality evidence. However, they can occasionally provide proof of cause and effect, and there are many other reasons for publishing them. Because an anecdote is a narrative, narratological paradigms from literature, art, and music can show how we can make evidential use of anecdotes. Useful paradigms are the dramatic unities (of time, place, and action), comprehensive catalogues, and pattern formations. Here I give examples of each of these types of paradigm and show how they can be used to interpret anecdotes about adverse drug reactions and interactions. The dramatic unities show how a proper classification of adverse drug reactions can be achieved, according to dose-relation, time-course, and susceptibility factors; use of this classification should improve the evidential use of anecdotal reports. A high background incidence of the effect (the medical equivalent of subplots, which violate the unity of action) makes it more difficult to detect adverse drug effects using anecdotal reports. To make best evidential use of the corpus of anecdotal reports of adverse drug reactions, comprehensiveness is important: each suspected adverse reaction should be reported in detail and reactions should be reported in sufficient numbers for proper classification and for patterns to be recognized. One form of pattern recognition, teleoanalysis of data, should, when possible, include not only randomized controlled trials and observational studies, but also case series and anecdotal reports. [ABSTRACT FROM AUTHOR]

AbstractEvidence is defined by its ability to establish or support conclusions. Evidence-based medicine (EBM) equates evidence with scientific evidence and views factors such as clinical expertise as important in moving from evidence to action. In contrast, we suggest that EBM should acknowledge multiple dimensions of evidence including scientific evidence, theoretic evidence, practical evidence, expert evidence, judicial evidence and ethics-based evidence. What EBM loses by not acknowledging these dimensions as evidence is the ability, among other things, to make and defend judgements based on understandings that complement science and are no less important than those science can offer. We argue for a new definition of EBM that, without forced accommodation or unacceptable compromise, acknowledges dimensions of evidence produced within and outside science. [ABSTRACT FROM AUTHOR]