Thanks Karen
Before reading Stephen Toulmin's book(s) I suggest that you look at the article about him in Wikipedia (http://en.wikipedia.org/wiki/Stephen_Toulmin), especially the section on "The Toulmin Model of Argument".
Although I believe that his ideas are an excellent antidote to the oversimplification often found in EBM (see PS 1) his language needs to be translated into EBM-speak. For example, if I were to talk about claims, data, warrents, backings, rebuttals, and qualifiers, I would need to ensure that my audience knew that these terms were being used with specialised meanings. At the level of a tourist's phrase book, a Toulmin-speak to EBM-speak dictionary might contain the following definitions: claim = recommendation; data = directly supporting evidence; warrent = indirectly supporting evidence; backing = reasoning, argument; rebuttal = exceptions/limits on applications; qualifier = qualifier, i.e. words or phrases expressing the speaker's degree of force or certainty concerning the recommendation. You might find these translations helpful when you read Toulmin.
Someone should write an article explaining in detail how the Toulmin model of argument could be used to improve the methodology of developing recommendations for EBP. (Don't ask. I am working on it. Slowly.)
Someone should also write an article about how strong the temptation to oversimplify is even in the most rational branches of medicine, and how to counteract it. (Don't ask. I am working on it. Very slowly.)
Michael
PS 1
Example of oversimplification: the paradigm for evidence supporting a recommendation is (or was) evidence from meta-analysis of the benefits (decreased mortality) from streptokinase asap after a myocardial infarct --- considerations of harms, costs, personal values and preferences, burden of treatments, and uncertainties in all these factors are of so little importance that they are "below the radar screen".
PS 2
No-one pointed out the error in the formula in the subject, so I will have to do it! It should read: Rational, ethical EBM = (evidence + values + clinical expertise)*judgement**transparency.
________________________________
From: KAREN UPTON [mailto:[log in to unmask]]
Sent: Thu 19/10/2006 22:51
To: M Power; [log in to unmask]
Subject: Re: Rational, ethical EBM = (evidence + values)*judgement**transparency
This is excellent news, I hope it will lead to a big improvement in NICE guidelines.
At present I am becoming increasingly concerned about the reult of the new GP GMS contract and NICE guidelines on treatment of patients who do not fit, ie the guidelines are not completely relevant to them.
The MacDonaldisation of medicine is very worrying.
I will try to get hold of the book you mention.
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