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Underdetermination in evidence‐based medicine
Author(s) -
ChinYee Benjamin H.
Publication year - 2014
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12258
Subject(s) - underdetermination , skepticism , epistemology , evidence based medicine , privilege (computing) , mechanism (biology) , medicine , psychology , philosophy of science , philosophy , alternative medicine , computer science , computer security , pathology
This article explores the philosophical implications of evidence‐based medicine's ( EBM's ) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the D uhem– Q uine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies.