In this chapter, we discuss how to evaluate evidence of mechanisms. This begins with an account of how a mechanistic study provides evidence for features of specific mechanism hypotheses, laying out a three step procedure of evaluating:(1) the methods used, (2) the implementation of the methods, and (3), the stability of the results. The next step is to combine those evaluations to present the quality of evidence of the general mechanistic claim.Having explained how evidence of mechanisms can be obtained, the next step is to evaluate that evidence, which is the topic of this chapter. In the following chapter will explain how this evaluation can be integrated with an evaluation of evidence for a correlation in order to determine an overall evaluation of the causal claim of interest.
A particular tradition in medicine claims that a variety of evidence is helpful in determining whether an observed correlation is causal. In line with this tradition, it has been claimed that establishing a causal claim in medicine requires both probabilistic and mechanistic evidence. This claim has been put forward by Federica Russo and Jon Williamson. As a result, it is sometimes called the Russo-Williamson thesis. In support of this thesis, Russo and Williamson appeal to the practice of the International Agency for Research on Cancer (IARC). However, this practice presents some problematic cases for the Russo-Williamson thesis. One response to such cases is to argue in favour of reforming these practices. In this paper, we propose an alternative response according to which such cases are in fact consistent with the Russo-Williamson thesis. This response requires maintaining that there is a role for mechanism-based extrapolation in the practice of the IARC. However, the response works only if this mechanism-based extrapolation is reliable, and some have argued against the reliability of mechanism-based extrapolation. Against this, we provide some reasons for believing that reliable mechanism-based extrapolation is going on in the practice of the IARC. The reasons are provided by appealing to the role of robustness analysis.
In this paper, I provide an introduction for biostatisticians and others to some recent work in the philosophy of medicine. Firstly, I give an overview of some philosophical arguments that are thought to create problems for a prominent approach towards establishing causal claims in medicine, namely, the Evidence-Based Medicine (EBM) approach. Secondly, I provide an overview of further recent work in the philosophy of medicine, which argues that mechanistic studies can help to address these problems. Lastly, I describe a novel approach for establishing causal claims in medicine that has been informed by this recent work in the philosophy of medicine, namely, the EBM+ approach.
Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. A more reliable type of reasoning may be distinguished by appealing to recent work on evidential pluralism in the epistemology of medicine. A case study from virology provides an example of this so‐called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine.
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