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Exposing the Vanities—and a Qualified Defense—of Mechanistic Reasoning in Health Care Decision Making

Published online by Cambridge University Press:  01 January 2022

Jeremy Howick
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Abstract

Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Yet evidence about mechanisms does not feature on dominant evidence-based medicine “hierarchies.” After arguing that only inferences from mechanisms (“mechanistic reasoning”)—not mechanisms themselves—count as evidence, I argue for a middle ground. Mechanistic reasoning is not required to establish causation when we have high-quality controlled studies; moreover, mechanistic reasoning is more problematic than has been assumed. Yet where the problems can be overcome, mechanistic reasoning can and should be used as evidence.

Type
Research Article
Information
Philosophy of Science , Volume 78 , Issue 5 , December 2011 , pp. 926 - 940
Copyright
Copyright © The Philosophy of Science Association

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Footnotes

‡

This article is a development of work written in collaboration with Paul Glasziou and Jeffrey Aronson. It was written while I was a recipient of an MRC/ESRC Interdisciplinary Postdoctoral Fellowship (G0800055) and a lecturer in the Science and Technology Studies Department at University College London. Nancy Cartwright read and made invaluable comments on earlier drafts of this article, and John Worrall has been a continued inspiration. I am also grateful to Claire Blacklock, Brendan Clarke, Lindley Darden, Foad Dizadji-Bahmani, Donald Gillies, Stuart Glennan, Adam La Caze, Federica Russo, Jon Williamson, John Worrall, Raffaella Campaner, Maria Carla Galavotti, and Sir Iain Chalmers for useful comments and discussions. I also received enormously helpful comments from almost everyone at the conference Mechanisms and Causality in the Sciences, especially Alex Broadbent, Carl Craver, Phyllis McKay Illari, and Bert Leuridan.

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