Rethinking bias and truth in evidence‐based health care. Greenhalgh, Weiringa, et al

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jep.13010
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Sietse Wieringa MSc DPhil Student, Scientia Research Fellow1,2 Eivind Engebretsen PhD, Professor1, Kristin Heggen, PhD, Professor1,
Trish Greenhalgh PhD, Professor3

In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence‐based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of “bias.” To prevent unwarranted relativism and make better inferences in clinical practice, clinicians may benefit from a closer analysis of existing assumptions about truth, validity, and reality.

We draw on Belgian philosopher Isabelle Stengers' work to demonstrate that bias means one thing if one assumes a world of hard facts “out there,” waiting to be col- lected. It means something different if one takes a critical view of the knowledge‐ power complex in research trials. Bias appears to have both an unproductive aspect and a productive aspect as argued by Stengers and others: Facts are not absolute but result from an interest, or interesse: a bias towards a certain line of questioning that cannot be eliminated.

The duality that Stengers' view invokes draws attention to and challenges the assumptions underlying the ideal limit theory of truth in several ways. Most impor- tantly, it casts doubt on the ideal limit theory as it applies to the single case scenario of the clinical encounter, the cornerstone of EBHC. To the extent that the goal of EBHC is to support inferencing in the clinical encounter, then the ideal limit as the sole concept of truth appears to be conceptually insufficient. We contend that EBHC could usefully incorporate a more pluralist understanding of truth and bias and pro- vide an example how this would work out in a clinical scenario.

KEYWORDS
epistemology, evidence‐based medicine, practical reasoning, science

 

What a load of woo-woo. I am wondering who this Trisha Greenhalgh lady is who has cropped up in relation to Cochrane. Professor of General Practice it seems, at QMUL. With views like this around it is not surprising Cochrane is going down the tube.

 

'Problematize'! Yikes.

 

The only discernible point being made in this paper is that people are inveterately biased towards caring about understanding things that they feel some motivation to care about. You only need one sentence to write this and it's not very insightful.

I have no idea what point the paper is trying to make in terms of researching and treating diseases. I didn't understand what they were trying to illustrate in the case study.

 

I didn’t get very far through the paper before my brain zonked out, so couldn’t tell how to evaluate it myself.

Am always interested in what critiques of EBM are out there, as something has failed. Need to find the best critiques, of course.

 

This is philosophy, and not very focused philosophy from my perspective. If you do not have a background in philosophy I would suggest avoiding it.

On focus, and I have not read it all so I might have to change my example, they fail to address the most important distinction on facts, that of objective and subjective observations. The biases in play are different between the two.

While attempting to avoid a social construction of reality argument, I am not clear they have not constructed another social construction of reality argument.

This is less an investigation into scientific philosophy, than it is an application of selections from the general philosophy of truth.

This article is, in my opinion, of little interest to ME patients or advocates. I may say more later. Philosophical debate tends to wander around, and something more relevant might be written later. I just do not expect it.