Abstract
Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM (evidence-based medicine) literature, although some recent authors have argued for an upgrade. Even so, the mechanistic reasoning that has received attention has almost exclusively been positive—both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessing medical interventions. This definition is wider than a previous suggestion in the literature. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to typical evidential strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and it presents a serious challenge to proponents of so-called medical hierarchies of evidence.
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Notes
Of course, an inference about an outcome not related to a medical intervention, e.g., an inference referring to the laws of gravitation, could be due to mechanistic reasoning, but hardly in the present context of interest.
It could be noted that several writers seem to take for granted that certain reasoning in which no mechanism is presented still qualifies as mechanistic. For example, Howick, Glasziou, and Aronson in spite of the denial in their own definition that such reasoning is mechanistic, write that “[m]any EBM proponents accept mechanistic reasoning…for…ruling out implausible hypotheses” [5, p. 433].
Quotation and medical claims taken from a manufacturer’s webpage, www2.valkee.com/uk/ [accessed September 18, 2014].
For example, they should not be interpreted to entail that a single study of a type higher up in the hierarchy always outweighs any number of studies belonging to types further down.
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Jerkert, J. Negative mechanistic reasoning in medical intervention assessment. Theor Med Bioeth 36, 425–437 (2015). https://doi.org/10.1007/s11017-015-9348-2
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DOI: https://doi.org/10.1007/s11017-015-9348-2