The use of mechanistic evidence in drug approval.

The role of mechanistic evidence tends to be under-appreciated in current evidence-based medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available.

Robustness and evidence of mechanisms in early experimental atherosclerosis research.

This article considers the evaluation of experimental evidence for a causal relation between cholesterol and atherosclerosis from the beginning of the 1900s until the late 1950s. It has been argued that the medical community failed to see the implications of this early research, and at first unjustifiably rejected a causal link between cholesterol and atherosclerosis. This article argues to the contrary that the medical community was justified to conclude based on the experimental evidence that cholesterol (dietary or blood) is probably not an effective target for preventive treatment.

Causation in evidence-based medicine: in reply to Kerry et al.

Kerry et al. criticize our discussion of causal knowledge in evidence-based medicine (EBM) and our assessment of the relevance of their dispositionalist ontology for EBM. Three issues need to be addressed in response: (1) problems concerning transfer of causal knowledge across heterogeneous contexts; (2) how predictions about the effects of individual treatments based on population-level evidence from RCTs are fallible; and (3) the relevance of ontological theories like dispositionalism for EBM.

Causal knowledge in evidence-based medicine. In reply to Kerry et al.'s causation and evidence-based practice: an ontological review.

In Causation and evidence-based practice: an ontological review, Kerry et al. argue that evidence-based practice (EBP) should revise its understanding of causation, and take on board a dispositionalist ontology. We point out that the challenges from complexity discussed by Kerry et al.

Synthetic biology and genetic causation.

Synthetic biology research is often described in terms of programming cells through the introduction of synthetic genes. Genetic material is seemingly attributed with a high level of causal responsibility. We discuss genetic causation in synthetic biology and distinguish three gene concepts differing in their assumptions of genetic control.