Causal Evidence and Dispositions in Medicine and Public Health

Abstract

Since the introduction of evidence-based medicine, there have been discussions about the epistemic primacy of randomised controlled trials (RCTs) for establishing causality in medicine and public health. A growing movement within philosophy of science calls instead for evidential pluralism: that we need more than one single method to investigate health outcomes. How should such evidential pluralism look in practice? How useful are the various methods available for causal inquiry? Further, how should different types of causal evidence be evaluated? This paper proposes a constructive answer and introduces a framework aimed at supporting scientists in developing appropriate methodological approaches for exploring causality. We start from the philosophical tradition that highlights intrinsic properties (dispositions, causal powers or capacities) as essential features of causality. This abstract idea has wide methodological implications. The paper explains how different methods, such as lab experiments, case studies, N-of-1 trials, case control studies, cohort studies, RCTs and patient narratives, all have some strengths and some limitations for picking out intrinsic causal properties. We explain why considering philosophy of causality is crucial for evaluating causality in the health sciences. In our proposal, we combine the various methods in a temporal process, which could then take us from an observed phenomenon (e.g., a correlation) to a causal hypothesis and, finally, to improved theoretical knowledge.

Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum

“…Patient experiences or narratives are considered an important part of evidence-based medicine, but are insufficiently incorporated in both research and practice. 52,53,61 Antidepressant users have reported severe and protracted withdrawal symptoms for decades via user surveys, help hotlines, or internet forums. 38,[62][63][64][65][66][67] Unfortunately, until very recently, medical associations, pharmaceutical companies, drug regulators, psychiatric academics, and practitioners have largely neglected or minimized this serious public health issue.…”

COVID-19 and Dispositions of the Chilean Healthcare System: Sociomedical Networks in Care Decisions of Chronic Illnesses

“… Rocca and Anjum (2020) take the idea of disposition and move it toward the medical field and evidence production. Medical evidence emerges from a given number of sources, but the most reliable evidence comes from the meta-analysis produced by randomized clinical trials, which ends up in the production of a clinical guide or protocol ( Howick et al, 2016 ).…”

“…In the sociomedical networks of a child living with SMA in Chile, each relationship in this assemblage obliges the family to make a health decision that does not necessarily involve a medical decision (e.g., the decision to sue the state) but still plays a big role in the medical outcome. In the study of medical causality, dispositions are causal powers or capacities ( Rocca and Anjum, 2020 ) that actants have but can only manifest in given sets of networks. Even though actants possess these dispositional properties, they only come to life within the networks and the relationships established in their dynamics.…”

Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research

“…After decades atop the hierarchy of evidentiary rigor in biomedicine and other fields, the place and reach of the RCT is being re-evaluated, 54 especially its distancing from prior knowledge in psychopharmacology, such as single-case studies, cross-over studies, observational studies, patient narratives, and history of ideas about how treatments work. 55 Outside this "cumulative science," an RCT cannot stand alone.…”