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Epidemiological Evidence: Use at Your ‘Own Risk’?

Published online by Cambridge University Press:  01 January 2022

Jonathan Fuller
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Abstract

What meaning does epidemiological evidence have for the individual? In evidence-based medicine, epidemiological evidence measures the patient’s risk of the outcome or the change in risk due to an intervention. The patient’s risk is commonly understood as an individual probability. The problem of understanding epidemiological evidence and risk thus becomes the challenge of interpreting individual patient probabilities. I argue that the patient’s risk is interpreted ontically, as a propensity. After exploring formidable problems with this interpretation in the medical context, I propose an epistemic reinterpretation of individual patient probabilities as credences. On this view, epidemiological evidence informs medical uncertainty.

Type
Biological Sciences and Medicine
Information
Philosophy of Science , Volume 87 , Issue 5: PSA 2018 - Proceedings of the 2018 biennial meeting of the Philosophy of Science Association. Part II Symposia Papers , December 2020 , pp. 1119 - 1129
Copyright
Copyright © The Philosophy of Science Association

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Footnotes

†

Thanks to Alex Broadbent, Steven Goodman, Stephanie Harvard, Stephen John, Richard Kravitz, David Spiegelhalter, Jacob Stegenga, and Mark Tonelli, as well as audiences at the 2018 Philosophy of Science Association biennial meeting in Seattle, the University of Toronto, the University of Bordeaux, and the University of Pittsburgh for helpful feedback and discussion.

References

Aronowitz, Robert. 2015. Risky Medicine: Our Quest to Cure Fear and Uncertainty. Chicago: Cambridge University Press.CrossRefGoogle Scholar
Djulbegovic, Benjamin, Hozo, Iztok, and Greenland, Sander. 2011. “Uncertainty in Clinical Medicine.” In Handbook of the Philosophy of Science, Vol. 16, Philosophy of Medicine, ed. Gabbay, D. M., Thagard, P., and Woods, J.. Amsterdam: Elsevier.Google Scholar
Fuller, J., and Flores, L. J.. 2015. “The Risk GP Model: The Standard Model of Prediction in Medicine.” Studies in History and Philosophy of Biological and Biomedical Sciences 54:49–61.CrossRefGoogle ScholarPubMed
Gillies, Donald. 2000. Philosophical Theories of Probability. London: Routledge.Google Scholar
Goff, D. C., et al. 2014. “2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Circulation 129:S49–S73.CrossRefGoogle Scholar
Goodman, S. N. 1999. “Probability at the Bedside: The Knowing of Chances or the Chances of Knowing?” Annals of Internal Medicine 130 (7): 604–6.CrossRefGoogle ScholarPubMed
Guyatt, Gordon, Rennie, Drummond, Meade, Maureen O., and Cook, Deborah J.. 2015. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd ed. New York: McGraw-Hill Education.Google Scholar
Hacking, Ian. 2001. An Introduction to Probability and Inductive Logic. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Hill, Austin Bradford. 1952. “The Clinical Trial.” New England Journal of Medicine 247:113–19.CrossRefGoogle ScholarPubMed
Kravitz, R. L., Duan, N., and Braslow, J.. 2004. “Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages.” Milbank Quarterly 82 (4): 661–87.CrossRefGoogle ScholarPubMed
Lewis, David. 1980. “A Subjectivist’s Guide to Objective Chance.” In Studies in Inductive Logic and Probability, Vol. 2, ed. Richard C. Jeffrey. Berkeley: University of California Press.Google Scholar
Matthews, J. Rosser. 1995. Quantification and the Quest for Medical Certainty. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
Clinic, Mayo. 2017. “Statin Choice Decision Aid.” https://statindecisionaid.mayoclinic.org/.Google Scholar
Stone, N. J., et al. 2014. “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Circulation 129:S1–S45.CrossRefGoogle Scholar
Tonelli, Mark, and Upshur, Ross E. G.. 2019. “A Philosophical Approach to Addressing Uncertainty in Medical Education.” Academic Medicine 94 (4): 507–11.CrossRefGoogle ScholarPubMed