David Hume's philosophy in relation to evidence based medicine

Extract

[...] Geddes and Harrision write that EBM is the “conscientious, explicit and judicious use of the current best evidence in making decision about the care of individual patients.”2 The kind of evidence in question is that provided through clinical trials. But there are issues about how to access or rank conflicting evidence. Geddes and Harrison assert that RCT's, or better still systematic reviews of RCT's, are the most reliable study design for the evaluation of treatments.3 But because such trials are not always available, Geddes and Harrison, following widely accepted principles of EBM (see, e.g. [...]

[...] It is this relation that underpins reasoning beyond our direct observations and binds unobserved facts to observed facts. “Were there nothing to bind them together, the inference would be entirely precarious.”7 However, Hume goes on to question what grounds our knowledge of cause-effect relations. He argues that this cannot be a piece of apriori reasoning and is instead based on our experience. Hume argues that both cause-effect relations concern separate events and thus no amount of inspection of the cause-event can yield knowledge of what effect it will lead to and also that the negation of cause-effect relations does not produce any logical contradiction or a state of affairs that cannot be distinctly conceived. [...]

[...] Thus the claim that the square of the hypotenuse is equal to the sum of the squares of the other two sides is a truth that is independent of whether there are any right-angled triangles in the universe. The negation of truths that comprise relations of ideas produces claims that could not have been true and cannot be ‘distinctly conceived by the mind.' By contrast, the negation of matters of fact could have been true and thus can be so conceived. [...]

[...] A proper understanding of the role of evidence in scientific psychiatry suggests the need to balance both bottom-up and top- down interdependence of evidence and theory. Part 1 Here we will explore Hume's skeptical argument and how it appears to undermine knowledge based on induction. Inductive reasoning reasoning from particular facts to generalizations plays an important role in science. Deductive reasoning reasoning from general principles to other general principles or to particular facts is important as well (as in the Hypothectio-Deductive method deployed in diagnosis), but it is induction that appears to be closely tied to the very idea of an empirical science. [...]

[...] (One cannot say routes to scientific knowledge; however, because Popper's influential falsification account denies that positive reasons for belief can be given in the face of Hume's problem.) Examining some of the conflicting responses made within the philosophy of science will highlight the role of the broader scientific context to the evidence that can be offered for scientific medical claims. The second kind of response is contained within a different branch of philosophy: epistemology. This branch concerns discussion of the nature (logos) of knowledge (episteme). [...]