this is old. see the new and ??improved Thesis Outline 2

Jan 07 … with some slow changes happening in Jan/Feb 08

EBM: Evolution, revolution or illusion (?i wonder how long I will like this title—Jan 08 and I still do) {[olive [I like it too. Jason] ]}

- Intro: A philosophical framework for EBM is yet to be provided. Worse. Piecing together what has been put forward as a justification for EBM (and its hierarchy) is inconsistent. I aim (i) to show that the framework provided by EBM proponents is inconsistent and (ii) provide a defensible philosophical framework for EBM (iii) show that the defensible framework provided in (ii) can’t do half of the things EBM proponents have suggested EBM can do; with special emphasis on the fact that it does NOT do well in informing therapeutic decisions (the very aim of EBM). {[olive I think this is a good plan, but the later parts of it are the going to be the best parts, so I suggest that you keep (i) short and/or add another point or two to it (which is probably what will happen of its own accord). The thing is that of course the justification for EBM is inconsistent. The justification for any huge project that’s put together by so many people is going to be inconsistent. That’s well worth saying, but it’s not as exciting as what you’re going to say under (iii). Unless I’m missing something. Jason ]} {[green By the way, I have a problem with the idea that “EBM does do well in informing therapeutic decisions”. I don’t think EBM does well in informing therapeutic decisions compared to the improved version of EBM which you’re going to be suggesting. And if that’s not what you’re comparing it to, then what? OK, maybe it does better than what we had before EBM; but then (despite what the EBM proponents say) it’s not actually that much different from what we had before EBM, so that’s a very hard comparison to make. Jason ]} {[red Thanks Jason. I’ll deal with green first. Egad! I made a typo. I am glad you don’t agree with EBM doing well to inform therapeutic decisions'; it doesn't, it's horrible at it. I forgot the _NOT_; now fixed. Re the fawn part: I might not be using the best word ininconsistent’. Any way I am not sure that (i)-(iii) will be three separable parts. Rather each chapter will attack all three. Say, Chapter 1: An interpretation of the hierarchy; Chapter 2: Why Randomise; Chapter 3: Therapeutic Decisions and the Problem of External Validity; Chapter 4: Statistical inference in EBM: General Principles; Chapter 5: Statistical inference in EBM: Rofecoxib; Chapter 6: A Philosophical Framework for EBM (if you still want to call it that). Progress report: I am about half way through Chapter 1. Chapter 2 and 5 are pretty much done. Chapter 4 I am looking forward to, and I think old versions of the rofecoxib paper will help. Chapter 3 needs doing, and there is a chance it could turn into a monster. Perhaps I will have to split it. (And thinking a little more, it might have to come after the statistical inference' chapters.) And Chapter 6 (I hope) will be summarising the positive threads from the earlier chapters. Adam ]} {[blue That's fantastic, or whatever a word is which means fantastic only even better! Can probably delete my comments above then. Do you want me to look at the chapters? Jason ]}{[black Ta. Shall clean up this page once I get around to fixing the chapter outline below. The chapters that I have considereddone’ you have read—I haven’t done `thesis’ versions yet. I hope to have chapter 1 done or close by the time I head off at the end of March, shall send through whatever I am up to then. Adam ]} Cool.

Section 1—EBM must be

- Interpreting the methodological hierarchy (incorporating: If it is going to make sense, E B M Must Not Be)

(propose the narrow way in which EBM, that is EBM+, might be justified and make clear the ways in which it is not; highlight challenges to EBM in reality)

- Why randomise

- Provide defense (if it is defendable) of EBM* (most likely within a philosophy of experiment context)… Perhaps use Patrick Suppes’ work for this

- The hierarchy of models (Suppes) and the interplay between the basic sciences and RCTs. This perhaps best links in with debates about the analysis of subgroups in clinical trials. Trialists: subgroups should be ignored, or at best, if interpreted at all, very very carefully. Pathophysiologists: the results in subgroups are vital for any inferences (they are the most important inferences).

Section 2..—The challenges of EBM in practice

- The problem of large, simple RCTs

- The problem of the use of classical statistics within EBM (largely the rofecoxib paper)

- EBM and external validity. (perhaps incorporating: The asymmetry of EBM). Perhaps linked to the notion of exchangeability, see Lindley Novick Paper

Other, miscellaneous

- Critique of Mayo and Spanos paper Br J Phil Sci

- Why informed consent is impossible