Key facts

Overview

History of science without philosophy of science is blind … philosophy of science without history of science is empty – Norwood Russell Hanson.

Galen, Maimonides, Avicenna, Descartes, and Locke were all medically qualified philosophers. More recently, Peter Medawar and Archie Cochrane were strongly influenced by Karl Popper. Recent studies suggest combining History and Philosophy of Science on the one hand, and health care on the other creates synergies for the mutual benefit of all disciplines.

Together with world leaders in philosophy, history, and EBHC (speakers include Professor Mike Kelly and Professor Nancy Cartwright), you will investigate:

• why/when controlled studies replaced reasoning from basic sciences and ‘expertise’
• the history and philosophy of ‘placebos’ and blinding
• the application of average treatment effects when treating individuals
• the role of values in deciding among treatments choices
• whether Evidence-Based Healthcare has done more good than harm
• how and why evidence synthesis (‘systematic reviews) arose
• the role of the sociology of science in Evidence-Based Healthcare

"The course will help me to structure my thinking about the advantages and limitations of EBM and to answer the questions I have about the interaction between EBM and the structure of current western healthcare systems."

"Gave me a completely different perspective on EBM. Eg. Being more specific about asking questions, being careful about language and terminology, being aware that non-medical folks look at the issues differently than medical ones, examining how philosophy might fit into my particular work."

"The content of the program (a very specific program regarding the background of EBM and its interaction with current healthcare systems), just where I was looking for!The luxury of a group of excellent lecturers. It was really nice to be exposed to such an enormous degree of expertise and inspiring idea's about EBM and healthcare! And that during a whole weekThe diversity of participants (countries, backgrounds, idea's)."

Description

Why study the history and philosophy of Evidence-Based Health Care (EBHC)?

• Become a better health care professional.Medical students who study the humanities perform better than those who focus exclusively on the sciences(Lancet 1996 (347:55-6), J Med Humanities 2004(30:53)).
• Learn to think more critically. Critical thinking is a pillar of analytic philosophy. You will be encouraged to question EBHC rather than accept it because it has become widely accepted. Our speakers have included influential critics of EBHC such as Ross Upshur and this year includes Nancy Cartwright.
• Become a better historian of medicine. The tutors on the course include Professor Ulrich Tröhler, Sir Iain Chalmers and Dr Mike Clarke Turner who will provide accounts of how EBHC arose, so the course is an invaluable case study.
• Why choose this course if you are neither a health care practitioner nor a philosopher or historian?. The lay press bombards us with claims that diets will cure disease, that new medical technology promises to prolong life, and that environmental factors will lead to premature death. Because of the interdisciplinary nature of the course, technical jargon particular to each discipline will be either entirely avoided or explained. Hence the course is accessible to anyone interested in understanding the nature, history, and justification for the kinds of health claims they face on a daily basis.
• Become a better writer. History and Philosophy of Science involves writing critical essays. The course involves workshops on essay writing and an online peer review process to help you develop your ideas.

There will be plenary lectures by professors Nancy Cartwright and Mike Kelly.

Programme details

Session topics

• An introduction to the history and philosophy of EBHC
• The introduction of quantification in assessing treatment effects
• The introduction of systematic reviews (evidence synthesis)
• The introduction of measures to ensure that like will be compared with like in treatment comparisons
• The history of blinding/masking to reduce observer biases
• Examining critiques of the EBHC stance on ‘pathophysiologic rationale’
• The philosophy of blinding/masking those involved in testing treatments
• Examination of arguments that average results are of questionable relevance to individuals
• The history of probabilistic thinking and statistical analysis in testing treatments
• What role does the sociology of science play?
• What are the explicit (and hidden) ways in which values come into (or should come into) EBHC?
• Views from the wild: applying philosophy of EBHC in actual health care practice

Staff

Sir Iain Chalmers

Role: Tutor

Coordinator, James Lind Initiative Iain Chalmers practised as a clinician for seven years in the UK and the Gaza Strip, before...more becoming a full time health services researcher. Between 1978 and 1992 he was founding director of the National Perinatal Epidemiology Unit. Between 1992 and 2002, he was founding director of the UK Cochrane Centre, which convened the meeting at which the Cochrane Collaboration was inaugurated. Since 2003, he has coordinated the James Lind Initiative to promote public and professional acknowledgement of the need to address uncertainties about the effects of treatments. He is coordinating editor of The James Lind Library and Testing Treatments Interactive.

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Professor Mike Clarke

Role: Tutor

Mike Clarke is Chair of Research Methodology and Director of the MRC all-Ireland Hub for Trials Methodology Research at Queen’s University,...more Belfast. He was awarded a first class BA in Chemistry at the University of Oxford in 1984, which included a one-year thesis on the history of drug abuse. This led to a DPhil on the history of suicide in England and Wales, with special emphasis on the use of poisons. He started work in healthcare research in 1989 at the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) in Oxford, where he became responsible for collaborative overviews of cancer treatments. In these, individual patient data are collected and analysed for all patients entered into relevant trials. The largest of the projects concerns the treatment of operable breast cancer and has provided reliable estimates of the effects of a variety of treatments, which influence the care of women with breast cancer worldwide. In April 1999, Mike took up the new post of Associate Director (Research) at the UK Cochrane Centre. He was Director of the Centre from October 2002 until March 2011, when he moved to Belfast.

Mike has considerable experience in the conduct of large multicentre randomised trials and systematic reviews. He is actively involved with trials in pre-eclampsia, subarachnoid haemorrhage, maternity care, breast cancer and poisoning - each of which are among the largest ever randomised trials in these conditions. Mike has been involved with the University of Oxford’s MSc in Evidence Based Health Care since the course began, and developed the Randomised Controlled Trials and the Systematic Reviews elective modules. He continues to teach both these modules.

Mike received the title Professor of Clinical Epidemiology from the University of Oxford in October 2004. He is a Visiting Professor of the Evidence Based Medicine and Clinical Epidemiology Centre of the West China School of Medicine in Chengdu, home of the Chinese Cochrane Centre, Adjunct Professor in the School of Nursing and Midwifery at Trinity College Dublin and Adjunct Professor at the National University of Ireland in Galway. In the last 20 years, Mike has published more than 200 papers and book chapters.

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Professor Bill Fulford

Role: Tutor

KWM (Bill) Fulford is a Member of the Philosophy Faculty, University of Oxford; and Emeritus Professor of Philosophy and Mental Health, University...more of Warwick Medical School. His previous posts include Honorary Consultant Psychiatrist, University of Oxford, and Special Adviser for Values-Based Practice in the Department of Health, in connection with which he held a Fellowship by Special Election at St Cross College. Bill has lead on a number of key academic and administrative developments in the philosophy of psychiatry and has published widely in this field, including, co-authoring The Oxford Textbook of Philosophy and Psychiatry. He is Lead Editor for the Oxford book series International Perspectives in Philosophy and Psychiatry, and Founder and Co-editor with John Sadler of the international journal Philosophy, Psychiatry, & Psychology (PPP), which he founded in 1993. His most recent book is the launch volume for a new book series from Cambridge University Press on Values-based Practice - Fulford, KWM, Peile, EP and Carroll, H., Essential Values-based Practice: Clinical Stories Linking Science with People (2012, Cambridge University Press). He is the lead editor for the forthcoming (2013) Oxford Handbook of Philosophy and Psychiatry.

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Prof Mike Kelly

Role: Tutor

Professor Mike Kelly is Director of the Centre of Public Health Excellence at National Institute for Health and Clinical Excellence (NICE) where...more he leads on the development of public health guidance. He is a public health practitioner, researcher and academic.

He originally graduated in Social Science from the University of York, holds a Masters degree in Sociology from the University of Leicester, and undertook his PhD in the Department of Psychiatry in the University of Dundee. Before joining NICE he was Director of Evidence and Guidance at the Health Development Agency. Professor Kelly has previously held academic posts at the Universities of Leicester, Dundee, Glasgow, Greenwich and Abertay. He is Honorary Senior Visiting Fellow in the General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Honorary Professor in the Department of Public Health and Policy at the London School of Hygiene and Tropical Medicine, Honorary Professor in Community Based Medicine, in the Faculty of Medical and Human Sciences, the University of Manchester, Visiting Professor in the School of Health and Related Research, University of Sheffield, Honorary Professor of Public Health, University of Salfordand Honorary Visiting Professor in the Department of Public Health, Primary Care and Food Policy in the School of Community and Health Sciences, City University, London. He is a Fellow of the Faculty of Public Health and an Honorary Fellow of the Royal College of Physicians.

He has published more than two hundred papers in medical, social scientific and public health journals and is author/ editor of seven books. In 2010 he was awarded the Alwyn Smith Prize of the Faculty of Public Health for his work on cardiovascular disease and alcohol misuse prevention.

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Professor Ulrich Tröhler

Role: Tutor

Professor Tröhler has worked extensively on the history of the fair evaluation of treatments. He is a member of: ...more

• University of Bern, Switzerland,
• German Academy of Sciences (Leopoldina),
• The Swiss Academy of Medical Sciences,
• Fellow of the Royal College of Physicians, Edinburgh.
• Founding President of the European Association for the History of Medicine and Health.

He is co-editor of the James Lind Library.

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Course aims

By the end of the course students will be able to:

• explain key philosophical concepts (‘epistemology’, ‘ontology’, ‘value theory’)
• defend and critique EBHC
• compare different historical approaches to understanding the origins of EBHC (quantification, the evolution of measures to reduce biases, statistical analysis of treatment tests)
• think critically
• write a philosophical or historical essay

Assessment methods

Students who wish to take the course for credit will be expected to write an extended essay of no more than 4000 words to a standard suitable for submission to a peer-reviewed journal. In this, students will be expected to explore, in depth, one aspect of the history and/or philosophy of EBHC. Essay topics will be chosen from a list (see below). Tutors from the course will supervise this work, and students will also act as peer reviewers and editors. Together with their supervisors, students will be encouraged to submit their essays to peer-reviewed journals.

The content and assignment for the module will be at a level that would be sufficient for 20 Masters level CATs.

Possible essay topics

1. Do evidence hierarchies have any useful purpose?
2. Why is ‘pathophysiologic rationale’ not ranked highly in EBHC hierarchies?
3. If ‘pathophysiologic rationale’ is undervalued as evidence for efficacy, can it play a role in generalizing the results of controlled studies, if so how?
4. What is the role of clinical expertise in EBHC?
5. What is the role of values in EBHC?
6. If randomised trials provide ‘best’ evidence, why don’t we need them to show that stopping massive bleeding saves lives?
7. Is CONSORT’s new policy on the importance of reporting the success of double blinding justified?
8. Is it ethical to conduct systematic reviews of unethical studies?
9. What are the historical roots of various aspects of EBHC methods?
10. When did medical textbooks first start paying attention to ‘evidence’?
11. How relevant is the year 1992 in the history of EBHC?

Level and demands

The main prerequisite for the course is enthusiasm for the subject. The course is designed to introduce students to the history and philosophy of EBHC and no background or education in history or philosophy will be required. Students will also generally be expected to have an undergraduate degree.

Recommended reading

The main texts associated with this course are:

• Howick, J. (2011) The Philosophy of Evidence-Based Medicine: a philosophical inquiry. Blackwell-Wiley.


• Chalmers I. James Lind Library: explaining and illustrating the evolution of fair tests of treatments. www.jameslindlibrary.org


• Tröhler U (2000). ‘To improve the evidence of medicine’: the 18th century British origins of a critical approach. Edinburgh: Royal College of Physicians. Available for free download from http://tinyurl.com/9blkdjo.


• Wootton, D. (2006) Bad Medicine. Oxford, Oxford University Press.


• Fulford, KWM, Peile E., and Carrol, H. (forthcoming [2011] Essential Values-Based Medicine: linking science with people. Cambridge, CUP.

Teaching methods

The course will combine face-to-face teaching in Oxford and online distance learning. During the teaching week we will use a combination of short lectures, interactive seminars, group work and in-class activities. There will also be preparatory reading and online interaction before and after the course, with follow-up on extended essay preparation.

Teaching outcomes

• be able to think more critically (decide what counts as an acceptable argument).
• successfully write an extended critical essay.
• be able to explain key ideas in philosophy, ‘epistemology’, ‘ontology’, ‘value theory’ the ‘rationalist/empiricist debate’, and ‘paradigm’.
• be able to defend and critique the EBM ‘hierarchy of evidence’ using philosophical principles’.
• be able to compare different historical approaches to the origins of EBHC (allocation, blinding, ‘placebo’ controls).
• be able to explain the role of values in EBHC.

Accommodation

Accommodation is available at the Rewley House Residential Centre, within the Department for Continuing Education, in central Oxford. The comfortable, en-suite, study-bedrooms are rated 3-star, and come with free high-speed internet access and TV. Guests can take advantage of the excellent dining facilities and common room bar, where they may relax and network with others on the programme.

Scholarships

Details of funding opportunities, including grants, bursaries, loans, scholarships and benefit information are available on our financial assistance page.

Fee options

Programme Fee

Students enrolled on MSc in Evidence-Based Health Care: £1500.00

Students enrolled on Postgraduate Dip in Health Research: £1500.00

Short course in health sciences: £1890.00

Apply for this course

Programmes including this module

This module can be studied as part of these programmes:

• MSc in Evidence-Based Health Care
• Postgraduate Diploma in Health Research
• Short courses in health sciences