Tonelli Mark R, Williamson Jon
University of Washington, Box 356522, 1959 NE Pacific St., Seattle, WA, 98195-6522, USA.
University of Kent, Canterbury, UK.
Med Health Care Philos. 2020 Mar;23(1):115-124. doi: 10.1007/s11019-019-09915-5.
While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice.
虽然机制在医学因果关系判定中的重要性目前是激烈辩论的主题，但机制性推理在临床实践中的作用却很少受到关注。在本文中，我们在治疗特定个体的背景下审视这个问题，并认为机制证据确实是临床实践各个方面的关键，包括评估群体层面的研究报告、诊断以及治疗决策，还有治疗效果评估。我们以肺部疾病支气管扩张症为例，说明机制性推理对临床实践的重要性。
