Predicting the Effectiveness of Medical Interventions
This dissertation explores several conceptual and methodological features of medical science that influence our ability to accurately predict medical effectiveness. Making reliable predictions about the effectiveness of medical treatments is crucial to mitigating death and disease and improving individual and population health, yet generating such predictions is fraught with difficulties. Each chapter deals with a unique challenge to predictions of medical effectiveness. In Chapter 1, I describe and analyze the principles underlying three prominent approaches to physical disease classification—the etiological, symptom-based, and pathophysiological models—and suggest a broadly pragmatic approach whereby appropriate classifications depend on the goal in question. In line with this, I argue that particular features of the pathophysiological model, such as its focus on disease mechanisms, make it most relevant for predicting medical effectiveness. Chapter 2 explores the debate between those who argue that statistical evidence is sufficient for inferring medical effectiveness and those who argue that we require both statistical and mechanistic evidence. I focus on the question of how mechanistic and statistical evidence can be integrated. I highlight some of the challenges facing formal techniques, such as Bayesian networks, and use Toulmin’s model of argumentation to offer a complementary model of evidence amalgamation, which allows for the systematic integration of statistical and mechanistic evidence. In Chapter 3, I focus on p-hacking, an application of analytic techniques that may lead to exaggerated experimental results. I use philosophical tools from decision theory to illustrate how severe the effects of p-hacking can be. While it is typically considered epistemically questionable and practically harmful, I appeal to the argument from inductive risk to defend the view that there are some contexts in which p-hacking may be warranted. Chapter 4 draws attention to a particular set of biases plaguing medical research: Meta-biases. I argue that biases of this type, such as publication bias and sponsorship bias, lead to exaggerated clinical trial results. I then offer a framework, the bias dynamics model, that corrects for the influence of meta-biases on estimations of medical effectiveness. In Chapter 5, I argue against the prominent view that AI models are not explainable by showing how four familiar accounts of scientific explanation can be applied to neural networks. The confusion about explaining AI models is due to the conflation of ‘explainability’, ‘understandability’, and ‘interpretability’. To remedy this, I offer a novel account of AI-interpretability, according to which an interpretation is something one does to an explanation with the explicit aim of producing another, more understandable, explanation.
Philosophy of Medicine, Medical Effectiveness
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