Treatment Effectiveness and the Russo–Williamson Thesis, EBM+, and Bradford Hill's Viewpoints

Abstract

ABSTRACT Establishing the effectiveness of medical treatments is one of the most important aspects of medical practice. Bradford Hill's viewpoints play an important role in inferring causality in medicine, and EBM+ seeks to improve evidence-based medicine, which is influential in establishing treatment effectiveness. At EBM+'s foundations lies the Russo–Williamson thesis (RWT), which can be seen as providing a reduction of Hill's viewpoints into those involving difference-making and mechanistic evidence, both of which are claimed by the RWT's proponents to be typically required for establishing causal claims in medicine. Yet little has been written on whether and how the RWT, EBM+, and Hill's viewpoints establish treatment effectiveness. This could be because of uncertainty over what treatment effectiveness is. I provide an account of treatment effectiveness, analysing the role of the RWT, EBM+, and Hill's viewpoints in this regard. I argue that Hill's viewpoints and EBM+ can be useful in helping to evaluate evidence, but cannot directly establish or confirm treatment effectiveness. This is partly because effectiveness, I claim, is subject to inductive risk and therefore determined by non-epistemic values, neither of which Hill's viewpoints nor EBM+ offer guidance on. I conclude by reinterpreting Hill's viewpoints in light of establishing treatment effectiveness.