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Underdetermination in evidence-based medicine.

Benjamin H Chin-Yee1

  • 1Faculty of Medicine, Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada.

Journal of Evaluation in Clinical Practice
|November 20, 2014
PubMed
Summary

Evidence-based medicine (EBM) faces underdetermination issues, limiting its ability to test core medical theories. A pluralistic approach integrating basic science and clinical research is crucial for advancing medical understanding and therapies.

Keywords:
Duhem-Quine thesisbasic scienceclinical researchevidence-based medicinephilosophy of sciencerandomized controlled trialunderdetermination

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Area of Science:

  • Philosophy of Science
  • Medical Epistemology
  • Evidence-Based Medicine

Background:

  • The Duhem-Quine thesis highlights how evidence underdetermines scientific theories.
  • Evidence-based medicine (EBM) prioritizes clinical research over basic science, potentially worsening this underdetermination.
  • This hierarchy may hinder the testing of fundamental medical beliefs about disease and treatment.

Purpose of the Study:

  • To explore the philosophical implications of EBM's epistemology.
  • To examine how EBM's hierarchy of evidence exacerbates the problem of underdetermination.
  • To assess the impact of underdetermination on medical theory testing and therapeutic development.

Main Methods:

  • Philosophical analysis of EBM's epistemological framework.
  • Application of the Duhem-Quine thesis to medical research hierarchies.
  • Critical examination of EBM's stance on basic biological sciences.

Main Results:

  • EBM's evidence hierarchy intensifies the underdetermination of medical theories.
  • Severe underdetermination prevents meaningful testing of core medical beliefs.
  • EBM adopts a skeptical view of basic science, limiting disease understanding to a population level.
  • This approach restricts the development of theoretical frameworks for disease mechanisms and novel therapies.

Conclusions:

  • EBM's current epistemological stance is limited and hinders theoretical advancement.
  • A pluralistic medical epistemology is necessary.
  • Integrating basic science and clinical research is vital for a comprehensive understanding of disease and development of new treatments.