Evidence and Hypothesis in Clinical Medical Science

TRAMA

In this book, the author argues that no current philosophical theory of evidence in clinical medical science is adequate. None can accurately explain the way evidence is gathered and used to confirm hypotheses. To correct this, he proposes a new approach called the weight of evidence account. This innovative method supplies a satisfactory explanation and rationale for the “hierarchical pyramid” of evidence–based medicine, with randomized clinical trials and their derivatives, meta-analyses, and systematic reviews of randomized clinical trials at the top and case reports, case series, expert opinion, and the like at the bottom. The author illustrates the development of various “levels” of evidence by considering the evolution of less invasive surgical treatments for early breast cancer. He shows that the weight of evidence account explains the notion of levels of evidence and other efforts to rank them. In addition, he presents a defense of randomization as a method to maximize accuracy in the conduct of clinical trials. The title also considers ethical issues surrounding experimentation with medical therapies in human subjects. It illustrates and discusses these issues in studies of respiratory therapies in neonates and treatment for certain cancers in adults. The author shows that in many cases sufficient evidence can be accrued to warrant generally accepted new therapies without the need for evidence derived from randomized clinical trials.

SOMMARIO

1. Introduction1.1 Aims and Motivation1.2 Overview of the Following ChaptersReferences2. Theories of Confirmation in which Hypotheses do not have Probabilities2.1 Hypothetico-Deductivism2.2 Hempel's "Satisfaction" Theory2.3 Mayo's Error-Statistical TheoryReferences3. Theories of Confirmation in which Hypotheses have Probabilities, and Inference to the Best Explanation3.1 General3.2 Bayesianism3.3 Achinstein's Theory of Evidence3.4 Inference to the Best Explanation3.4.1 What is an Explanation?3.4.2 Evidence, Hypothesis, and Explanation in Clinical Medical ScienceReferences4. Confirmation of Hypotheses in Clinical Medical Science4.1 General4.2 Therapeutic Hypotheses4.2.1 Controlled Trials4.2.2 N of 1 Trials4.3 Etiologic Hypotheses4.3.1 Cohort Studies4.3.2 Case-Control Studies4.3.3 Cross-Sectional Studies4.3.4 Remarks on the Challenges of Etiologic Research4.4 Diagnostic HypothesesReferences5. A Weight of Evidence Account5.1 General5.2 Some Threats to Accuracy5.2.1 Selection Bias5.2.2 Information Bias5.2.3 Confounding5.3 How is the Weight of Evidence Determined?5.3.1 Cochrane Systematic Reviews5.3.2 IARC Reviews5.4 How is the Weight of Evidence Quantified?5.5 The Importance of AccuracyReferences6. The Weight of Evidence Account Defended6.1 General6.2 Current Theories of Evidence are Unsatisfactory for Clinical Medical Science6.3 The Weight of Evidence Account Remedies Deficiencies in other Accounts6.4 The Weight of Evidence Account Explains the Case Studies6.5 The Weight of Evidence Account Explains Efforts to Rank EvidenceReferences7. Justification for the Hierarchical Pyramid of Evidence-Based Medicine and a Defense of Randomization7.1 General7.2 The Evolution of Treatments for Early Breast Cancer7.2.1 Background7.2.2 Early Studies7.2.3 Controlled Trials in Clinical Medical Science Revisited7.2.4 RCTs in Early Breast Cancer7.3 Is Randomization Necessary?7.4 A Defense of Randomization7.5 Analysis of Evidence in Studies of Treatment for Early Breast Cancer7.6 Some Issues in Generalizing the Results of RCTs in Clinical Medical Science7.7 Why the Hierarchical Pyramid of EBM is JustifiedReferences8. Ethics and Evidence: Is Evidence from Randomized Controlled Trials Necessary to Firmly Establish a New Therapy?8.1 General8.2 ECMO8.2.1 Background and RCTs of ECMO8.2.2 Were the ECMO RCTs Necessary?8.3 Carcinoma of the Anal Canal8.4 Disseminated Carcinoma of the Testis8.5 ConclusionsReferences               Index

AUTORE

John A. Pinkston, MD is a practicing Radiation Oncologist in Birmingham, AL. Dr. Pinkston graduated from University of Miami Leonard M Miller School of Medicine in 1968 and has been in practice for 49 years. He received his M.D. and Ph.D. (in philosophy) from the University of Miami. Dr. Pinkston completed residencies at the United States Naval Medical Center and at the Stanford University Medical Center. He received a Doctor of Public Health (Dr.P.H.) from the University of Alabama, Birmingham. Dr. Pinkston served as a Research Associate in the Department of Medicine, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan and as a Clinical Associate Professor of Radiation Oncology, University of Alabama, Birmingham.

ALTRE INFORMAZIONI

• Condizione: Nuovo
• ISBN: 9783030442699
• Collana: Synthese Library
• Dimensioni: 235 x 155 mm Ø 454 gr
• Formato: Copertina rigida
• Illustration Notes: XIII, 152 p. 3 illus.
• Pagine Arabe: 152
• Pagine Romane: xiii