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17 EBM+: increasing the systematic use of mechanistic evidence
  1. Jon Williamson
  1. University of Kent, Canterbury, UK


Objectives The EBM+ programme seeks to ensure that existing evidence of mechanisms is systematically evaluated when assessing the effectiveness of an intervention or the effects of an exposure. Basing assessments on mechanistic studies in addition to clinical studies leads to more reliable assessments and can sometimes speed up the time taken to make decisions.

The objectives of this paper are to:

  1. Describe the aims of the EBM+ programme;

  2. Explain the rationale behind the EBM+ programme;

  3. Describe EBM+ methods for systematically assessing mechanistic evidence;

  4. Discuss the feasibility of the EBM+ approach.

Method Objectives 1-3 of the paper will be met by discussing the EBM+ programme as set out by Parkkinen et al. (2018), Evaluating evidence of mechanisms in medicine, Springer,

The EBM+ programme arose from recent philosophical work on the epistemology of causality. Objectives 1 and 2 will be met by explaining what this work is, why it is new and interesting, and how it could lead to more systematic use of existing evidence in medicine and public health.

Objective 3, an account of the EBM+ methods for assessing mechanistic evidence, will be met by providing an overview of the methods set out in Parts II and III of Parkkinen et al. (2018), which cover (i) gathering evidence of mechanisms; (ii) evaluating evidence of mechanisms; and (iii) using evidence of mechanisms to evaluate efficacy and external validity.

Objective 4 will be met by providing a new feasibility analysis of EBM+.

Results The results of the feasibility analysis include:

  • A critical analysis of four different grounds for thinking the EBM+ approach might be feasible to implement in practice. Two of these lines of argument are shown to fail, while two are shown to provide good evidence for the feasibility of EBM+.

  • A critical analysis of the objection that the EBM+ approach is prone to bias and subjectivity. Four responses to that objection are considered, with one shown to fail and three to be successful.

Conclusions EBM+ is shown to provide a promising programme for making better use of existing evidence when assessing interventions and exposures.

Concerns about infeasibility, bias and subjectivity can be allayed, although some attempts to tackle these concerns are unsuccessful.

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