Posted by zeugma on September 22, 2006, at 21:59:56 [reposted on September 25, 2006, at 0:09:09 | original URL]
In reply to Re: conceptual free market elucidation... » zeugma, posted by alexandra_k on September 22, 2006, at 20:15:02
Supervenience. Most people accept this little hierarcy:
Psychology
Biology
Chemistry
MicrophysicsIt is controversial whether you get to put consciousness on the top... I'm not sure whether to deal with events, facts, processes, properties or what... But if we deal with facts the notion is the low level facts fix the high level facts whereas the converse is not the case. Some people reckon you can put sociology on top (Not sure whether that goes on top of consciousness... Perhaps) because the social facts are fixed by the individuals psychological facts (and the environmental facts but if you are a broad content person then you probably get environmental facts for free in the psychological facts).
So... If that is right maybe the medical paradigm just gets plugged in to the biological level of analysis>>
OK, but not so fast. Because there is a conflict between the biological, mechanistic explanation, and the statistical nature of disease:
<Evidence can be interpreted in many ways, partly because the knowledge we acquire through clinical trials, especially the RCT, is statistical in nature (meaning that the results are based on effects observed on populations). In combination with the selection of study variables, outcome units, and level of statistical significance, this inevitably leads to uncertainty in dealing with individual patients>
What I take this to mean is that although supervenience may be true, one is dealing with probablilities rather than certainties (and thus there is no determinism). I know this is not expressed perfectly in the article I am quoting from, but it appears that adherents of the RCT in psychiatry (as elsewhere) accept the assumption that statistics supercede basic science (predicated on molecular-level mechanisms, say) in evaluating treatments. OK< I'm not getting this right. The 'numerical method' basicially claims that supervenience can't be followed through, because one needs to arrive inductively at answers to medical questions, and induction has inherent limitations which preclude supervenience.
anyway. politics, and the NHS:
http://jme.bmjjournals.com/cgi/content/full/30/2/171
I agree with the following statement:
<Evidence based medicine brings us to the question of power over the clinical encounter: will it be the doctor, the patient, or the payer who decides what kinds of treatment are delivered and on what basis? It is likely that this tension is contributing to the apparently growing frustration of doctors worldwide.33 Restating traditional medical ethics will not solve the problems because the economic crisis of medicine is here to stay, but requiring doctors to combine both traditional and modern duties is not a simple solution either. It is possible that the profession will split into two: doctors who can afford to follow traditional ethics with wealthy patients, and doctors trying to deliver the best possible care to poorer patients within the financial constraints imposed from above. This gap is likely to widen along with the scientific development and commodification of health care.34 Clinical practice guidelines have an internal logic that will make them more and more binding in the long run. It is also important to note the potential frustration of patients: paternalism in medicine has long been in decline and patient autonomy has been promoted to the extent that patients now tend to be called "clients" of health care. Evidence based medicine used for rationing will equally limit the autonomy of both the doctor and his/her clients. In conclusion, it would appear that using practical EBM for cost control may easily become the European equivalent of managed care.>
-z
poster:zeugma
thread:688931
URL: http://www.dr-bob.org/babble/social/20060922/msgs/688947.html