CFP: Topoi Special Issue on Evidence, Expertise and Argumentation in Evidence-Based Medicine

Journal: TOPOI

Guest Editors: Fabrizio Macagno and Carlo Martini

As medical sciences are progressing towards more data-based methodologies, the role of clinical judgment is often subsidiary to the quality and weight of evidence, understood as a product of statistical and methodological analysis of data. In this special issue we focus on: 1) the relationship between statistical evidence and the justification of clinical judgments, and 2) the communication of evidence by experts (clinicians). The process of retrieval and analysis of scientific data and development of clinically relevant research has a crucial communicative challenge to face. In order to use the best evidence-based research to make decision about the care of patients, it needs to be integrated with clinical expertise and more importantly with patient values. Sharing information and making evidence available to patients is regarded as fundamental for “supporting patients to consider different alternatives or priorities” (Elwyn et al., 2014) namely making informed decisions.

In this sense, evidence-based practice needs to address the problems of shared decision making, grounded on the concepts of patient-centered care and patient engagement. Not only needs evidence to be shared with the patients (that is, adjusted to their background knowledge) but patient’s unique preferences, concerns, and expectations need to be integrated into clinical decision. 

The role of argumentation becomes pivotal in this framework. Evidence belongs to any discourse in health care, as it plays a justificatory role. It provides a means to support arguments and test assertions. Proposals need to be argued for and against by relying on evidence; evidence, in turn, needs to be shared and debated. For this reason, not only does a theory of argumentation and argument evaluation become crucial in health communication, but also the different types of dialectical purposes investigated in argumentation theory can shed light on how evidence is discussed and used to achieve a communicative goal. Depending on whether the interlocutors intend to share information, make a decision, negotiate, or persuade each other, evidence is used and evaluated in different ways.

Evidence-based practice is thus argumentative for two reasons. On the one hand, evidence needs to be communicated effectively for the intended communicative goal, namely making a shared decision grounded on patient’s preferences. On the other hand, evidence needs to be assessed, debated, and evaluated in a dialectical process, which involves understanding of the argumentative structure of the various types of evidence. Expert opinion, generalizations grounded on statistical data, and best explanation are the most common scientific reasons provided to support a claim in doctor-patient communication. Providing methods for evaluating them is of crucial importance for improving the quality of shared decision-making.

The argumentative use and the assessment of evidence in medical decision-making also opens some critical dilemmas related to the two aforementioned dimensions of communicating and assessing evidence. In the first dilemmatic scenario, a medical expert may give an opinion that is different from the official judgment as established through statistical and quantitate means. The patient will then be left with the conundrum of which evidence to rely on: the apparently transparent and logical evidence of the numbers? Or the evidence from the arguments the clinician might offer in support of her or his decision to stray from the numbers? In this scenario, it becomes important to understand how to integrate clinical expert judgment with evidence-based practices. In the second dilemmatic situation, two doctors, presented with apparently the same evidence from diagnostics and clinical examinations, come to different conclusions. In this scenario, the patient will be left to decide which arguments to listen to, from two different and possibly equally competent experts. In the latter scenario, it becomes important to highlight the role and weight of expert disagreement in medical argumentation. 

The two dilemmatic scenarios presented above underscore the fundamental role of expertise. Evidence itself, without expertise and judgment, is of little use to science users, i.e., the patients, without arguments supporting one or another conclusion in a clinical situation. But how do experts transmit evidence to the public? What is their role as mediators between the evidential base of science and the science users? Can we understand this role only as a sociological and, sometimes, political issue? Or is there a possibility for a methodology of expertise? 

This special issue will focus on the relationship between argumentation and the critical use of evidence in medical decision-making. In particular, the research question is whether the current concepts and accounts of evidence and expertise are adequate for capturing the subjective, reason-based and argumentative component of evidence-based medical science, as well as the role of experts as mediators and communicators. The topics of interest include the following: 

• Evidence assessment in medical sciences;

• Expertise and statistical judgment in medical sciences;

• Effective communication of evidence in medical sciences; 

• Conflicting evidence and disagreement in medical decision-making; 

• Evidence and argumentation in medical sciences;

• Medical decisions under uncertainty.

Submission procedure:

We invite scholars to submit additional papers to be included in this Special Issue. Articles should not exceed 7000 words. All papers will be subject to double-blind peer-review, following international standard practice. 

All papers must be prepared for double-blind refereeing. Anonymised papers must be submitted through the editorial manager http://www.editorialmanager.com/topo/default.aspx by selecting, under new submission: S.I. : Evidence-Based Medicine (Martini/Macagno)  

Submission deadline: 1st September 2018

For any further information please contact: [email protected], [email protected]