10. A Qualified Defence of the EBM Stance on Mechanistic Reasoning

  1. Jeremy Howick1,2

Published Online: 23 MAR 2011

DOI: 10.1002/9781444342673.ch10

The Philosophy of Evidence-Based Medicine

The Philosophy of Evidence-Based Medicine

How to Cite

Howick, J. (2011) A Qualified Defence of the EBM Stance on Mechanistic Reasoning, in The Philosophy of Evidence-Based Medicine, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444342673.ch10

Author Information

  1. 1

    Centre for Evidence-Based Medicine, Department of Public Health and Primary Care, University of Oxford, Oxford, UK

  2. 2

    Department of Science and Technology Studies, University College London, London, UK

Publication History

  1. Published Online: 23 MAR 2011
  2. Published Print: 8 APR 2011

ISBN Information

Print ISBN: 9781405196673

Online ISBN: 9781444342673



  • qualified defence of EBM stance - on mechanistic reasoning;
  • mechanisms, being the rage in philosophical work on causality - ontological claims made on their behalf;
  • philosophers of science - arguing that mechanisms are required for understanding;
  • mechanisms, playing essential roles - in underwriting causal regularities in life sciences, central role in supporting claims about effectiveness of medical interventions;
  • problems, besetting mechanistic evidence use - claims about effects of medical interventions;
  • mechanistic reasoning, best understood - EBM movement, strongest evidential support;
  • mechanisms, in antiarrhythmic drug action - acting as the “black box”;
  • Russo and Williamson's antisepsis on Helicobacter pylori - linking smoking and lung cancer, not accepted, until their mechanisms were understood;
  • epistemological problems, with mechanistic reasoning - biochemical mechanisms and inferential chain;
  • EBM proponents, and role for high-quality mechanistic reasoning - in their evidence hierarchies


This chapter contains sections titled:

  • A tension between proponents of mechanistic reasoning and EBM views

  • Clarifying the terminology: comparative clinical studies, mechanisms, and mechanistic reasoning

  • Why the strong view that mechanistic reasoning is necessary to establish causal claims is mistaken

  • Two epistemological problems with mechanistic reasoning

  • Why EBM proponents should allow a more prominent role for high-quality (valid and based on “complete” mechanisms) mechanistic reasoning in their evidence hierarchies

  • Mechanisms and other roles in clinical medicine

  • Recommending a (slightly) more important role for mechanistic reasoning in the EBM system

  • Appendix: cases where mechanistic reasoning led to the adoption of therapies that were either useless or harmful according to well-conducted clinical research