Global evidence, local needs: Lessons from practical philosophy about using different knowledge

Target audience: Guideline and systematic review developers; users of guidelines and systematic reviews, including practitioners and policy makers.  

Level of knowledge required is basic – a basic understanding of evidence-based practice is needed, no prior knowledge of philosophy is required.  Participants should be interested in the use of evidence in local contexts and how practical philosophy can support our understanding and use of different knowledge.

Practical philosophy aids understanding that enables participants to integrate evidence to produce guidelines and systematic reviews for complex, real-world practice.

Policy or clinical recommendations cannot solely rely upon evidence from meta-reviews of large, randomised studies (1). They often need to draw upon multiple types of knowledge to achieve knowledge translation (2-4). Novel practices of evidence integration are increasingly informed by philosophical concepts on complex causality. These make explicit the epistemological choices involved in making an inference and their methodological consequences (6-8). Recent approaches describe how evidence appraisal and synthesis can incorporate and accommodate diverse knowledge needs (6, 9, 10). So we ask, 'How can different types of knowledge help provide guidance in real-world settings? What can we learn from philosophical understandings of inference, prediction and explanation (11)?'

Key examples from contexts that are complex, resource constrained and human rights sensitive show how approaches that move beyond traditional understandings of methodological rigour are needed. Although these contexts are found around the world, the global South may well be a forerunner when it comes to innovative evidence assessment. This Special Session and its accompanying three workshops open an active dialogue between innovative evidence synthesis practices and cutting-edge developments in the philosophy of knowledge.

Session structure:
Three empirical cases on knowledge synthesis, followed by philosophical responses and interaction with the audience.

Session chair:
James Thomas

General introduction and session outline:
Jackie Chandler and Teun Zuiderent-Jerak

Case 1: Outbreak prevention and control
Presenter: Rodrigo Pardo Turriago on Zika and observational knowledge in the Americas
Discussant: Jon Williamson on Mechanistic reasoning

Case 2: Complex interventions in social care
Presenter: Beth Shaw on Social care guidance in NICE
Discussant: Jackie Chandler on Complex causality

Case 3: Standards for gender and human rights
Presenter: Teun Zuiderent-Jerak on Transgender guideline in Argentina
Discussant: Sietse Wieringa on ethical assumptions in evidence

Discussion with the audience: focus on questions raised by and lessons learned from the dialogue.

Overall discussant: Trish Greenhalgh (University of Oxford)

1. Burgers JS and Van Everdingen JJE. Beyond the evidence in clinical guidelines. The Lancet, 2004. 364(July 31):  392-93.
2. Zuiderent-Jerak, T, Forland F and Macbeth F. Guidelines should reflect all knowledge, not just clinical trials. British Medical Journal, 2012: 345(e6702).
3. Sackett DL, et al., Evidence based medicine: what it is and what it isn't. British Medical Jounal, 1996. 312(7023): 71-72.
4. Haynes RB, et al., Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. Evidence-Based Medicine, 1996. 1(7): 196-198.
5. Ophir A and Shapin S. The Place of Knowledge; a Methodological Survey. Science in Context, 1991. 4(1): 3–21.
6. Wieringa S, et al. Different knowledge; different styles of reasoning. A challenge for guideline development. draft.
7. Reiss J. Causation, Evidence, and Inference. 2015: Routledge.
8. Verran H. Science and an African Logic. 2001, Chicago: University of Chicago Press.
9. Lukersmith S, et al. A new framing approach in guideline development to manage different sources of knowledge. J Eval Clin Pract, 2016 - online first.
10. Harder T, et al. Towards a framework for evaluating and grading evidence inpublic health. Health Policy, 2015. 119(6): 732–736.
11. Illari P and Russo F. Causality: Philosophical theory meets scientific practice. 2014: Oxford University Press.

Note that this Special Session consists of a track of three events: the following two workshops are connected to this session:
Workshop 1: Understanding context in evidence synthesis and guideline development.
Workshop 2: Applying current philosophical insights on causality using qualitative comparative analysis as an additional synthesis in systematic reviews to address complex interventions.


Target audience: 

Guideline and systematic review developers; users of guidelines and systematic reviews, including practitioners and policy makers.

Type of session: 

This session will introduce philosophical accounts around real-world problems through three short presentations with philosophical reflections followed by two overall discussants. After an initial Q&A, participants will talk with their neighbours on specific question, then share highlights in a managed large group discussion including the panel.

Other contributors:

Greenhalgh T1, Kyamanywa P2, Shaw B3, Thomas J4, Pardo Turriago R5, Williamson J6, Wieringa S7
1 Oxford University, UK
2 , Rwanda
3 National Institute for Health and Care Excellence, UK
4 University College London, UK
5 Universidad Nacional de Colombia, Columbia
6 University of Kent, UK
7 University of Oslo, Norway


Wednesday 13 September 2017 - 16:00 to 17:30