What does philosophy have to do with evidence-based healthcare?

Philosophy is notoriously abstract. Imagine a philosopher and you might conjure up images of a somewhat impractical person, sat in a parlour fancifully asking ‘why?’ without giving much thought to the ‘how’. So what could such a person contribute to medicine, one of the most practical and useful disciplines going?

Evidence-based healthcare (EBHC), especially, conjures (to my mind, at least) images of diligent hands-on people, treating patients or using rigorous empirical methods to research the best ways to improve people’s health. What could be more far removed?

Well, here’s the thing: EBHC is itself a philosophical position!

You see, philosophy is really just trying to figure out answers to questions about the world that can’t be settled through scientific methods like observation and experiment. For example, epistemology is a branch of philosophy concerned with knowledge. It tries to understand what it is to know something. Philosophers think about the world and try to create theories about how things work, which they then test to destruction through argument and critique, only to come out the other side with something more refined and (hopefully) closer to the truth. It’s hard, and progress is slow, but every now and then an idea comes along that makes a real step forward. The principles of EBHC are one of those steps forward. The irony of course is that in the case of EBHC, it wasn’t even academic philosophers who made the leap! Read into the history of EBHC and the names you’ll find didn’t work in philosophy departments. But even though these pioneers were medics and scientists, I’d still argue that in their own way, they were being philosophers.

So what is EBHC? Well, David Sackett described it as “integrating individual clinical expertise with the best available external clinical evidence from systematic research”. But hang on, weren’t doctors always trying to use the best evidence?

Well, of course they were. You see, EBHC, when you get down to it, is fundamentally a theory about what constitutes good evidence about healthcare. While the traditional ‘evidence pyramid’ is an oversimplification, evidence from well-conducted randomized trails should generally be trusted more that non-randomized observational evidence, or expert testimony. This important leap wasn’t discovered through experimentation (though lots of experiments have since bolstered the case for EBHC), but by thinking critically about healthcare and about evidence.

Why does this matter? When people criticise the practices of EBHC, or when we disagree about the best way forward in settling our favourite controversial healthcare policy questions (come on, we all have them), we’re often not arguing about what the evidence says, but how we should interpret it and how we should weigh different kinds of evidence against each other. This is philosophy, so maybe by learning the tools of philosophy we can become better practitioners of EBHC.

You might be thinking: ‘hang on, if EBHC is philosophy, where’s the line between philosophy and scientific methods, then?’ and rightly so! It turns out that’s a tricky question, but if we’re prepared to think critically and philosophically when we’re doing science, then maybe it doesn’t really matter where the line is. After all, if we’re doing EBHC then what we care about is results, right?

Philosophical questions permeate everything we do, including the research and practice of healthcare. That’s why thinking philosophically about these things (even if you’re not a philosopher) is so important if we’re to keep on the right track.

We dig deeper into these questions, and others, in our MSc module on the History and Philosophy of Evidence-based Healthcare.