Evidence-based Policies? The Covid-19 Pandemic and the Prospects of Evidence Integration

  1. Giorgio Airoldi 1
  2. Davide Vecchi 2
  1. 1 Universidad Nacional de Educación a Distancia
    info

    Universidad Nacional de Educación a Distancia

    Madrid, España

    ROR https://ror.org/02msb5n36

  2. 2 Universidade de Lisboa
    info

    Universidade de Lisboa

    Lisboa, Portugal

    ROR https://ror.org/01c27hj86

Revista:
Teorema: Revista internacional de filosofía

ISSN: 0210-1602

Año de publicación: 2021

Título del ejemplar: Filosofía de la medicina / Philosophy of medicine

Volumen: 40

Número: 1

Páginas: 175-197

Tipo: Artículo

Otras publicaciones en: Teorema: Revista internacional de filosofía

Resumen

Para justificar sus políticas durante la pandemia de Covid-19, los gobiernos han implícitamente recurrido, sobre todo en las fases iniciales, a una versión sesgada de la ‘medicina basada en la evidencia`, una filosofía de la medicina que se basa especialmente en la evidencia computacional y estadística. Este enfoque muestra al menos una debilidad relevante: ignora gran parte de las evidencias clínicas y mecanicistas y su potencial contribución a la comprensión y la gestión de le enfermedad. Argumentamos que un enfoque pluralista de la evidencia, centrado en la integración, podría apoyar mejor la lucha contra esta y futuras pandemias.

Información de financiación

ACKNOWLEDGMENTS We would like to thank the reviewers for particularly stimulating comments. Davide Vecchi acknowledges the financial support of the FCT - Fundação para a Ciência e a Tecnologia (DL57/2016/CP1479/ CT0072; Grant N. UIDB/ 00678/ 2020; R&D Project Grant PTDC/FER-HFC/30665/2017 “Emergence in the Natural Sciences: Towards a New Paradigm”. Giorgio Airoldi contributed to this article as part of the research project MECABIOSOC “Mechanisms across the Sciences: From Biology to the Social” (FFI2017-89639-P).

Financiadores

Referencias bibliográficas

  • BEALE, S., HAYWARD, A., SHALLCROSS, L., ALDRIDGE, R. W., FRAGASZY, E. (2020), ‘A Rapid Review of the Asymptomatic Proportion of PCRConfirmed SARS-CoV-2 Infections in Community Settings’; medRxiv 2020.05.20.20108183; doi: https://doi.org/10.1101/2020.05.20.20108183.
  • BLUHM, R. (2005), ‘From Hierarchy to Network: A Richer View of Evidence for Evidence-Based Medicine’; Perspect Biol Med 48(4), pp. 535–547. doi:10.1353/ pbm.2005.0082.
  • CARR A. C. (2020), ‘A New Clinical Trial to Test High-Dose Vitamin C in Patients with COVID-19’; Critical care, 24(1), p. 133. https://doi.org/10.1186/ s13054-020-02851-4.
  • CARTWRIGHT, N & HARDIE, J (2012), Evidence-Based Policy: A Practical Guide to Doing It Better; Oxford: Oxford University Press.
  • CHARLTON, B.G. & MILES, A. (1998), ‘The Rise and Fall of EBM’; Quarterly Journal of Medicine 91(5), pp. 371—374
  • CLARKE, C. & GILLIES, D & ILLARI, P & RUSSO, F & WILLIAMSON, J (2013), ‘The Evidence that Evidence-Based Medicine Omits’; Preventive Medicine, Volume 57, Issue 6, pp. 745-747, ISSN 0091-7435, https://doi.org/10.1016/ j.ypmed.2012.10.020.
  • CLARKE, B. et al. (2014), ‘Mechanisms and the Evidence Hierarchy’; Topoi 33.2, pp. 339–360.
  • COHEN, A.M. et al. (2004), ‘A Categorization and Analysis of the Criticisms of Evidence-Based Medicine’; International Journal of Medical Informatics 73, pp. 35-43.
  • COOK, D. & MULROW, C. & HAYNES, R. (1997), ‘Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions’; Annals of Internal Medicine, 126, pp 376-80.
  • COOPER, R.S. et al. (2003), ‘Race and Genomics’; New England Journal of Medicine 348(12), pp. 1166-70. doi: 10.1056/NEJMsb022863.
  • DAVIDOFF, F et al. (1995), ‘Evidence-Based Medicine’, British Medical Journal, 310 (6987), pp. 1085-1086.196
  • EASTMAN, R.T. et al. (2020), ‘Remdesivir: A Review of Its Discovery and Development Leading to Emergency Use Authorization for Treatment of COVID-19’; ACS Cent. Sci., 6, pp. 672−683. https://pubs.acs.org/doi/ 10.1021 /acscentsci.0c00489.
  • EROL, A (2020), ‘High-Dose Intravenous Vitamin C Treatment for Covdi19 (a mechanistic approach)’; https://www.seme.org/site/docs/covid19/Erol_2020 _ High_dose_Intravenous_vitaminC_Covid19.pdf, Retrieved June 26th, 2020
  • FLACCO, M.E. (2020), ‘SARS-CoV-2 Lethality Decreased Over Time in Two Italian Provinces’. medRxiv preprint doi: https://doi.org/10.1101/2020. 05.23. 20110882.
  • GARVIN, M.R. et al. (2020), ‘A Mechanistic Model and Therapeutic Interventions for COVID-19 Involving a RAS-Mediated Bradykinin Storm’; eLife 9:e59177. doi: 10.7554/eLife.59177.
  • GUARALDI. G. et al. (2020), ‘Tocilizumab in Patients with Severe COVID-19: a Retrospective Cohort Study’; Lancet Rheumatology. Published online June 24th, 2020 https://doi.org/10.1016/S2665-9913(20)30173-9.
  • GRÜNE-YANOFF, T. (2016), ‘Why Behavioural Policy Needs Mechanistic Evidence’, Economics and Philosophy 32.3, pp. 463-483.
  • HARKO, T., LOBO, F.S.N., MAK, M. K. (2014), ‘Exact Analytical Solutions of the Susceptible-Infected-Recovered (SIR) Epidemic Model and of the SIR Model with Equal Death and Birth Rates’; Applied Mathematics and Computation, 236(1), pp. 184-194.
  • HIGGINS JPT, G. S., ed. (2009), ‘Cochrane Handbook for Systematic Reviews of Interventions’; available from www.cochrane-handbook.org. The Cochrane Collaboration, version 5.0.2 [updated september 2009] edition.
  • HORNER, J.K., SYMONS, J.F. (2020), ‘Software Engineering Standards for Epidemiological Modeling.’ arXiv:2009.09295. https://arxiv.org/abs/ 2009.09295.
  • ILLARI, P. (2011), ‘Mechanistic Evidence: Disambiguating the Russo–Williamson Thesis’; International Studies in the Philosophy of Science, 25, pp. 139–157.
  • ILLARI, P & WILLIAMSON, J (2012), ‘What is a Mechanism? Thinking About Mechanisms Across the Sciences’, European Journal for Philosophy of Science, 2 (1): pp. 119-135.
  • JEFFERSON, T & HENEGHAN, C (2020), ‘Modelling the Models’, https://www.cebm.net/ covid-19/modelling-the-models/ Retrieved June 26th, 2020.
  • KERMACK, W. O. & MCKENDRICK, A. G. (1927), ‘A Contribution to the Mathematical Theory of Epidemics’; Proceedings of the Royal Society A. 115 (772): pp. 700–721. Bibcode:1927RSPSA.115..700K. doi:10.1098/rspa.1927.0118.
  • LAVEZZO,E.ET AL. (2020), ‘Suppression of Covid-19 Outbreak in the Municipality of Vo’, Italy’, medRxiv preprint doi: https://doi.org/10.1101/ 2020.04. 17. 20053157.
  • LI L, ZHANG W, HU Y, et al. (2020), ‘Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients with Severe and Life-Threatening COVID-19: A Randomized Clinical Trial’; JAMA. Published on-line June 03, 2020. doi:10.1001/jama.2020.10044.
  • FAN LU, Y. et al. (2014), ‘Personalized Medicine and Human Genetic Diversity’; Cold Spring Harbor Perspectives on Medicine, 4:a008581. doi: 10.1101/cshperspect.a008581.
  • MARCHIONNI C & REIJULA S. (2018), ‘What is Mechanistic Evidence, and Why Do We Need it for Evidence-Based Policy?’; Stud Hist Philos Sci., 73, pp. 54-63. doi:10.1016/j.shpsa.2018.08.003.
  • MACINTYRE CR & CHUGHTAI AA (2015), ‘Facemasks for the Prevention of Infection in Healthcare and Community Settings’ BMJ, 350, p. h694.
  • PETTICREW M & ROBERTS H (2003), ‘Evidence, Hierarchies, and Typologies: Horses for Courses’; J Epidemiol Community Health 57(7), pp. 527–529.
  • RUSSO, F & WILLIAMSON, J (2007), ‘Interpreting Causality in the Health Sciences’; International Studies in the Philosophy of Science 21.2, pp. 157–170.
  • SACKETT D. L. & ROSENBERG W.M. & GRAY J.A &, HAYNES R.B. & RICHARDSON W.S. (1996), ‘Evidence Based Medicine: What It Is and What It Isn’t.’, BMJ. 312 (7023): pp. 71-72. doi:10.1136/bmj.312.7023.71.
  • SEKINE, T. et al. (2020), ‘Robust T Cell Immunity in Convalescent Individuals with Asymptomatic or Mild COVID-19’; Cell 183(1): 158-168.e14. doi: 10.1016/j.cell.2020.08.017.
  • SINGH CHAWLA, D. (2020), ‘Influential Pandemic Simulation Verified by Code Checkers’; Nature, 582: pp. 323-324
  • STEGENGA, J. (2014), ‘Down with the Hierarchies’, Topoi 33: pp. 313-322. https://doi.org/10.1007/s11245-013-9189-4.
  • VERITY, R. et al. (2020), ‘Estimates of the Severity of Coronavirus Disease 2019: A Model-Based Analysis’; Lancet Infectious Diseases 20: 669–77. https:// doi.org/10.1016/ S1473-3099(20)30243-7.
  • VICTORA C.G. & HABICHT J.P. & BRYCE J., (2004), ‘Evidence-Based Public Health: Moving Beyond Randomized Trials’; Am J Public Health 94, pp. 400-405.