Rationality and the generalization of randomized controlled trial evidence

Journal of Evaluation in Clinical Practice 19 (4):644-647 (2013)
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Abstract

Over the past several decades, we devoted much energy to generating, reviewing and summarizing evidence. We have given far less attention to the issue of how to thoughtfully apply the evidence once we have it. That’s fine if all we care about is that our clinical decisions are evidence-based, but not so good if we also want them to be well-reasoned. Let us not forget that evidence based medicine (EBM) grew out of an interest in making medicine ‘rational’, with the idea that rational clinical evaluations should be evidence-based. I agree with the uncontroversial statement that the best decision is supported, at least in part, by the best available evidence. Rationality, however, is constituted by reasoning, not evidence. Complete arguments are necessary for rational evaluations, arguments that begin with general evidence and end in a conclusion about a particular patient. In order to traverse these inferential gaps, medicine must address the issue of how to establish, as an intermediate premise, what the evidence has to say about the efficacy of an intervention for particular patients in a particular practice setting.

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Citations of this work

Measuring effectiveness.Jacob Stegenga - 2015 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 54:62-71.
The Risk GP Model: The Standard Model of Prediction in Medicine.Jonathan Fuller & Luis J. Flores - 2015 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 54:49-61.
Effectiveness of medical interventions.Jacob Stegenga - 2015 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 54:34-44.
The Risk GP Model: The standard model of prediction in medicine.Jonathan Fuller & Luis J. Flores - 2015 - Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 54:49-61.

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References found in this work

Conjectures and Refutations.K. Popper - 1963 - Les Etudes Philosophiques 21 (3):431-434.
Conjectures and Refutations.Karl Popper - 1963 - British Journal for the Philosophy of Science 19 (2):159-168.
Are rcts the gold standard?Nancy Cartwright - 2007 - Biosocieties 1 (1):11-20.
The limitations of randomized controlled trials in predicting effectiveness.Nancy Cartwright & Eileen Munro - 2010 - Journal of Evaluation in Clinical Practice 16 (2):260-266.

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