In The Reasoner: on therapeutic inferences for individual patients.

This month sees the publication of a philosophy themed edition of the Journal of Evaluation in Clinical Practice. The edition contains a number of articles on the nature of health, disease, diagnosis and care, and a section on rethinking medical epistemology. There is also a debates section, which is made up of responses to papers from a previous edition of the journal. The topics discussed there include the nature of causality and also whether evidence-based medicine is failing as a result of industry contamination of research. I recommend that interested readers of The Reasoner take a look at the edition.

One article in the edition is by Luis Flores (King’s College, London) and is on Therapeutic inferences for individual patients. Flores focuses on the issue of applying the probability estimates provided by clinical trials to individual patients. It is generally acknowledged that these generic estimates are not straightforwardly applicable to a particular patient, but that methodological developments in the design and analysis of clinical trials may overcome this obstacle. But Flores argues against the view ‘that recent developments in research methodology have resulted in improved clinical trials capable of providing clinicians with probability estimates readily applicable to individuals’. He thinks that clinicians should not rely solely on developments in research methodology in order to address the problem of maximizing the relevance of probability estimates for individual patients. Instead, Flores argues that clinicians should also reflect upon the particular characteristics of each patient. He concludes that the problem of applying probability estimates to individual patients can be addressed by considering a variety of evidence and not just that evidence which results from clinical trials.

This is a conclusion close to the heart of the Evaluating evidence in medicine project, which is funded by the AHRC and begins this month. This is a collaboration between researchers at UCL, the University of Kent, the University of Amsterdam, NICE, IARC, the Institute of Public Health at Cambridge University, and the Medical School at Leiden University. The project aims to understand how to best consider evidence of mechanisms alongside statistical evidence in medical research and health policy. Interested readers can keep up to date with the project at the EBM+ blog.

 The Reasoner is a monthly digest highlighting exciting new research on reasoning, inference and method broadly construed. It is interdisciplinary, covering research in, e.g., philosophy, logic, AI, statistics, cognitive science, law, psychology, mathematics and the sciences. Each month, there is a column on Evidence-Based Medicine. This month’s issue includes the following:

Readers of this blog might want to keep checking in with The Reasoner from time to time.