Does reductio ad absurdum have a place in evidence-based medicine?

BMC Medicine

Bruno Falissard²  Florian Naudet¹ 

[1] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France;AP-HP, Hôpital Paul Brousse, Département de Santé Publique, Villejuif, France

关键词: Statistics;    Reductio ad absurdum;    Publication bias;    Evidence-based medicine;    Epistemology;   

Others  :  797838
DOI  :  10.1186/1741-7015-12-106

 received in 2014-05-23, accepted in 2014-05-23,  发布年份 2014

【 摘 要 】

In a meta-analysis published in BMC Medicine, we explored whether evidence-based medicine can actually be sure that ‘sucrose = sucrose’ in the treatment of depression. This paper, based upon a reductio ad absurdum, addressed an epistemological question using a ‘scientific’ approach, and could be disconcerting as suggested by Cipriani and Geddes’ commentary. However, most papers are based upon a mixture of observations and discussions about sense and meaning. Ultimately, there is nothing more than a story, told with words or numbers. Randomised controlled trials provide information about average patients that do not exist. These results ignores an entire segment of therapeutics that plays a crucial role, namely care. This information is usually set out using a ‘grammar’ that is ambiguous, since statistical tests of hypothesis have raised epistemological questions that are not as yet solved. Moreover, many of these stories remain untold, and unpublished. For these reasons evidence-based medicine is a vehicle for many paradoxes and controversies. Reductio ad absurdum can be useful in precisely this case, to underline how and why the medical literature can sometimes give an impression of absurdity of this sort. Even if the data analysis in our paper was rather rhetorical, we agree that it should comply with the classic standards of reporting and we provide the important extra data that Cipriani and Geddes have requested.

Please see related articles: http://www.biomedcentral.com/1741-7015/11/230 webcite and http://www.biomedcentral.com/1741-7015/12/105 webcite.

【 授权许可】

   
2014 Naudet and Falissard; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Naudet F, Millet B, Charlier P, Reymann JM, Maria AS, Falissard B: Which placebo to cure depression? A thought-provoking network meta-analysis. BMC Med 2013, 11:230. BioMed Central Full Text
• [2]Cipriani A, Geddes JR: Placebo for depression? We need to improve the quality of scientific information but also reject too simplistic approaches or ideological nihilism. BMC Med 2014, 12:105.
• [3]Falissard B, Revah A, Yang S, Fagot-Largeault A: The place of words and numbers in psychiatric research. Philos Ethics Humanit Med 2013, 8:18. BioMed Central Full Text
• [4]Cartwright N: A philosopher’s view of the long road from RCTs to effectiveness. Lancet 2011, 377:1400-1401.
• [5]Lehmann EL: The Fisher, Neyman-Pearson Theories of testing hypotheses: one theory or two? In Selected Works of E L Lehmann. Edited by Rojo J. New York: Springer US; 2012:201-208. Selected Works in Probability and Statistics
• [6]Nuzzo R: Scientific method: statistical errors. Nature 2014, 506:150-152.
• [7]Johnson VE: Revised standards for statistical evidence. Proc Natl Acad Sci U S A 2013, 110:19313-19317.
• [8]Collier R: Prevalence of ghostwriting spurs calls for transparency. CMAJ 2009, 181:E161-162.
• [9]Joober R, Schmitz N, Annable L, Boksa P: Publication bias: what are the challenges and can they be overcome? J Psychiatry Neurosci 2012, 37:149-152.
• [10]Turner EH: Publication bias, with a focus on psychiatry: causes and solutions. CNS Drugs 2013, 27:457-468.
• [11]Groves T, Godlee F: The European Medicines Agency’s plans for sharing data from clinical trials. BMJ 2013, 346:f2961.
• [12]European Parliament: Clinical trials: clearer rules, better protection for patients [press release]. 2014. [http://www.europarl.europa.eu/news/en/news-room/content/20140121IPR33307/html/Clinical-trials-clearer-rules-better-protection-for-patients webcite]
• [13]Davis JM, Giakas WJ, Qu J, Prasad P, Leucht S: Should we treat depression with drugs or psychological interventions? a reply to Ioannidis. Philos Ethics Humanit Med 2011, 6:8. BioMed Central Full Text
• [14]Ioannidis JP: Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? Philos Ethics Humanit Med 2008, 3:14. BioMed Central Full Text
• [15]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009, 6:e1000100.