It is surely obvious that medicine, like any other rational activity, must be based on evidence. The interest is in the details: how exactly are the general principles of the logic of evidence to be applied in medicine? Focussing on the development, and current claims of the ‘Evidence-Based Medicine’ movement, this article raises a number of difficulties with the rationales that have been supplied in particular for the ‘evidence hierarchy’ and for the very special role within that hierarchy of randomized (...) controlled trials (and meta-analyses of the results of randomized controlled trials). The point is not at all to question the application of a scientific approach to evidence in medicine, but, on the contrary, to indicate a number of areas where philosophers of science can contribute to a proper implementation of exactly that scientific-evidential approach. (shrink)

In clinical and agricultural trials, there is the danger that an experimental outcome appears to arise from the causal process or treatment one is interested in when, in reality, it was produced by some extraneous variation in the experimental conditions. The remedy prescribed by classical statisticians involves the procedure of randomization, whose effectiveness and appropriateness is criticized. An alternative, Bayesian analysis of experimental design, is shown, on the other hand, to provide a coherent and intuitively satisfactory solution to the problem.

The first part of this paper reveals a conflict between the core principles of deterministic causation and the standard method of difference, which is widely seen as a correct method of causally analyzing deterministic structures. We show that applying the method of difference to deterministic structures can give rise to causal inferences that contradict the principles of deterministic causation. The second part then locates the source of this conflict in an inference rule implemented in the method of difference according to (...) which factors that can make a difference to investigated effects relative to one particular test setup are to be identified as causes, provided the causal background of the corresponding setup is homogeneous. The paper ends by modifying the method of difference in a way that renders it compatible with the principles of deterministic causation. (shrink)

The requirement of randomization in experimental design was first stated by R. A. Fisher, statistician and geneticist, in 1925 in his book Statistical Methods for Research Workers. Earlier designs were systematic and involved the judgment of the experimenter; this led to possible bias and inaccurate interpretation of the data. Fisher's dictum was that randomization eliminates bias and permits a valid test of significance. Randomization in experimenting had been used by Charles Sanders Peirce in 1885 but the practice was not continued. (...) Fisher developed his concepts of randomizing as he considered the mathematics of small samples, in discussions with "Student," William Sealy Gosset. Fisher published extensively. His principles of experimental design were spread worldwide by the many "voluntary workers" who came from other institutions to Rothamsted Agricultural Station in England to learn Fisher's methods. (shrink)

It is sometimes thought that randomized study group allocation is uniquely proficient at producing comparison groups that are evenly balanced for all confounding causes. Philosophers have argued that in real randomized controlled trials this balance assumption typically fails. But is the balance assumption an important ideal? I run a thought experiment, the CONFOUND study, to answer this question. I then suggest a new account of causal inference in ideal and real comparative group studies that helps clarify the roles of confounding (...) variables and randomization. 1Confounders and Causes2The Balance Assumption3The CONFOUND Study 3.1CONFOUND 13.2CONFOUND 24Disjunction C and the Ideal Study 4.1The ultimate ‘other cause’: C4.2The ideal comparative group study4.3Required conditions for causal inference5Confounders as Causes, Confounders as Correlates6Summary. (shrink)

Glenn Harrison [Journal of Economic Methodology, 2013, 20, 103–117] discusses four related forms of methodological intolerance with respect to field experiments: field experiments should rely on some form of randomization, should be disconnected from theory, the concept of causality should only be defined in terms of observables, and the role of laboratory experiments is dismissed. As is often the case, the cause of intolerance is ignorance, as it is here. To acquire knowledge about potential influences, which we need for both (...) the evaluation of internal and external validity of experimental results, we cannot do without theory. A purely empiricist methodology will be unable to give us sufficient understanding of the validity of these results. An account of causality only based on directly observed things, is an account based on factual influences only. This account will be too restricted, because it will not deal with the unobserved potential influences, which we need – again – for the evaluat... (shrink)