How to Guide Use of Evidence of Mechanis

Welcome to another episode of The Words Matter Podcast.

We have reached the final few episodes of the clinical reasoning series; and I hope you have enjoyed the journey up to this point. This series and the podcast more broadly is made possible by all the Patreon support, and ever a huge thank you for those supporting the show and to those listening and sharing the podcast with your friends, colleagues and students. 

On this episode I’m speaking with Dr Elena Rocca and Dr Saúl Pérez-González about how evidence of biological mechanisms can support our clinical reasoning.

Elena is an associate professor at Oslo Metropolitan University, and specializes in issues related to responsible knowledge-based decision-making with focus on risk and safety of medicines, both from a practical, methodological and philosophical perspective. Her work is interdisciplinary between scientific evidence, practice, policy and philosophy. Elena's research includes causality assessment in drug safety, clinical reasoning, analysis of expert disagreement. Elena is part of The CauseHealth team and we spoke several times on the CauseHealth Series on probability, medical uniqueness, causal dispensationalism and philosophy for practice.

Saúl is a Post-doctoral research fellow at the Center for Logic, Language, and Cognition in the Department of Philosophy and Educational Sciences at the University of Turin. Italy. He has a background in philosophy, with a PhD in Philosophy and MA in Contemporary Philosophical Thought. He is currently Working on/Member of the PRIN research project “From Models to Decisions” Funded by the Italian Ministry of University and Research.

Saúl has held Visiting researcher positions at Centre for Humanities Engaging Science and Society - Durham University the Centre for Philosophy of Social Science - University of Helsinki.

In this episode we talk around a paper that Saul and Elena wrote together titled 'Evidence of Biological Mechanisms and Health Predictions: An Insight into Clinical Reasoning' published in the journal Perspectives in Biology and Medicine.

So on this episode we speak about: 

• What is meant by the term ‘mechanisms’ and what constitutes of them.
• How evidence of mechanisms is typically portrayed and valued in the epistemological and methodological hierarchies of evidence-based medicine.
• How evidence of mechanisms can be useful to our clinical reasoning by helping us make predictions around safety and efficacy of treatment interventions for individual patients.
• The potential the dangers of relying on mechanistic knowledge in replacement of knowledge about effectiveness (such as knowledge generated from clinical trial).
• How evidence of mechanisms can take any form of study design; from lab-based animal studies to understand biological mechanisms at play to qualitative studies to understand the mechanisms involved in the processes of the social world.
• How evidence of mechanisms is generally more decisive for discarding inadequate interventions than for identifying suitable ones.

This was yet another enlightening conversation and quite distinct from the previous episodes on the series. As such, it adds to rounding and deepening the view of clinical reasoning that this series seeks to offer.

Find Elena and Saúl on Twitter 

@ElenaRoccaPD

@SaulPerGon

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