The History and Philosophy of Evidence-Based Health Care
Why and how did evidence-based medicine arise, and why should you accept it?
Students will engage with researchers who have played key roles in defining the History, Philosophy and actual practice of Evidence-Based Healthcare. Many famous medical doctors, including Galen, Descartes and Locke, were also philosophers, and recent evidence suggests that studying humanities improves clinical skills. Medical professionals will learn to think critically about the assumptions of their profession while philosophers and historians will learn about the empirical foundations of the science they contemplate.
Every 'edition' of the course is different because we explore cutting edge debates within the course. Discussions of nocebo (negative placebo) effects are a new addition to the course, as well as whether Evidence-Based Health Care is powerful enough to overcome financial and academic conflicts of interest.
Students are encouraged to discuss and engage actively with all the tutors, during all sessions.
Tutors on the course include:
Dr Jeremy Howick (University of Oxford)
Professor Ulrich Tröhler (Emeritus Professor of the History of Medicine, University of Bern)
Professor Bill Fulford (University of Oxford)
Professor Mike Clarke (Queen's University, Belfast and Editor of the James Lind Library)
Dr Andrew Papanikitas (University of Oxford)
Why study the history and philosophy of Evidence-Based Health Care (EBHC)?
- Improve your clinical skills. 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)).
- Deepen your ability to gain philisophical insight. Philosophy of science without history of science is empty; history of science without philosophy of science is blind.
- Gain accounts of how Evidence-Based Health Care arose from some of the key figures involved in its conception. These include Professor Mike Clarke, and Sir Iain Chalmers.
- 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, Professor Nancy Cartwright, Dr Amanda Burls and Professor Rom Harre.
- 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. It is important for all of us to be able to critically evaluate these claims. Because of the interdisciplinary nature of the course, technical jargon particular to each discipline will be either entirely avoided or explained. 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. Many students have published their essays in peer reviewed journals.
There are will also be plenary sessions led by leading experts within the field of EBHC.
Comments from previous participants:
"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)."
- What is the philosophy of EBHC?
- Does EBHC work? (What is the evidence that EBHC has done more good than harm?)
- The introduction of quantification in assessing treatment effects
- The introduction of systematic reviews (evidence synthesis)
- History of comparing like with like
- The history of blinding/masking to reduce observer biases
- Should EBHC include a more prominent role for evidence of mechanisms?
- The philosophy of placebo and nocebo effects
- Examination of arguments that average results are of questionable relevance to individuals
- The history of probabilistic thinking and statistical analysis in testing treatments
- Power versus rationality: EBHC versus financial and academic conflicts of interest
- How do (or should do) values play a role in EBHC?
- Views from the wild: applying philosophy of EBHC in actual health care practice
- Howick J (2011). The Philosophy of Evidence-Based Medicine. Blackwell-Wiley. Chapters 1-3
- Chalmers I. James Lind Library: explaining and illustrating the evolution of fair tests of treatments. www.jameslindlibrary.org
The following is also recommended as part of this module.
- Wootton, D. (2006) Bad Medicine. Oxford, Oxford University Press.
- Fulford, KWM, Peile E., and Carrol, H. (2012) Essential Values-Based Medicine: linking science with people. Cambridge, CUP.
Accommodation is available at the Rewley House Residential Centre, within the Department for Continuing Education, in central Oxford. The comfortable, en-suite, study-bedrooms have been rated as 4-Star Campus accommodation under the Quality In Tourism scheme, and come with tea- and coffee-making facilities, free Wi-Fi access and Freeview 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.
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Short Course in Health Sciences: £2285.00
Students enrolled on MSc in Evidence-Based Health Care: £1850.00
Students enrolled on Postgraduate Dip in Health Research: £1850.00
Details of funding opportunities, including grants, bursaries, loans, scholarships and benefit information are available on our financial assistance page.
If you are an employee of the University of Oxford and have a valid University staff card you may be eligible to receive a 10% discount on the full stand-alone fee. To take advantage of this offer please submit a scan/photocopy of your staff card along with your application. Your card should be valid for a further six months after attending the course.
Dr Jeremy Howick is a Senior Researcher, Nuffield Department of Primary Care Health Sciences and the NSPCR Non-Clinical Research Fellow.
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
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.
By the end of the course students will
- 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.
Possible essay topics
- Do evidence hierarchies have any useful purpose?
- Why is ‘pathophysiologic rationale’ not ranked highly in EBHC hierarchies?
- If ‘pathophysiologic rationale’ is undervalued as evidence for efficacy, can it play a role in generalizing the results of controlled studies, if so how?
- What is the role of clinical expertise in EBHC?
- What is the role of values in EBHC?
- If randomised trials provide ‘best’ evidence, why don’t we need them to show that stopping massive bleeding saves lives?
- Is CONSORT’s new policy on the importance of reporting the success of double blinding justified?
- Is it ethical to conduct systematic reviews of unethical studies?
- What are the historical roots of various aspects of EBHC methods?
- When did medical textbooks first start paying attention to ‘evidence’?
- How relevant is the year 1992 in the history of EBHC?
Applicants may take this course for academic credit. The University of Oxford Department for Continuing Education offers Credit Accumulation and Transfer Scheme (CATS) points for this course. Participants attending at least 80% of the taught course and successfully completing assessed assignments are eligible to earn credit equivalent to 20 CATS points which may be counted towards a postgraduate qualification.
Applicants can choose not to take the course for academic credit and will therefore not be eligible to undertake the academic assignment offered to students taking the course for credit. Applicants cannot receive CATS (Credit Accumulation and Transfer Scheme) points or equivalence. Credit cannot be attributed retrospectively. CATS accreditation is required if you wish for the course to count towards a further qualification in the future.
A Certificate of Completion is issued at the end of the course.
Applicants registered to attend ‘not for credit’ who subsequently wish to register for academic credit and complete the assignment are required to submit additional information, which must be received one calendar month in advance of the course start date. Please contact us for more details.
Please contact email@example.com if you have any questions.
This course requires you to complete the application form and to attach a copy of your CV. If you are applying to take this course for academic credit you will also need to complete section two of the reference form and forward it to your referee for completion. Please note that if you are not applying to take the course for academic credit then you do not need to submit a reference.
Please ensure you read the guidance notes which appear when you click on the symbols as you progress through the application form, as any errors resulting from failure to do so may delay your application.
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.
This course can be taken with academic credit (assignment of up to 4,000 words) or without academic credit, please indicate on your form which option you are applying for.
To apply for the course you should:
- be a graduate or have successfully completed a professional training course
- demonstrate an interest in the history or philosophy of evidence-based healthcare, either through graduate study or professional work
- be able to combine intensive classroom learning with the application of the principles and practices of evidence-based health care within the work place
- have a good working knowledge of email, internet, word processing and Windows applications (for communications with course members, course team and administration)
- show evidence of the ability to commit time to study and an employer's commitment to make time available to study, complete course work and attend course and university events and modules.
If you have any questions about your eligibility, please contact Jeremy Howick, module coordinator, directly on Jeremy.firstname.lastname@example.org
Terms and conditions
Terms and conditions for applicants and students on this course
Sources of funding
Information on financial support