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HELLO AND WELCOME.

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MY NAME IS JOSHUA GORDON,

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DIRECTOR OF THE NATIONAL

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INSTITUTE OF MENTAL HEALTH AND

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CO-CHAIR OF THE EXECUTIVE

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COMMITTEE FOR ADVANCING BASIC

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BEHAVIORAL SOCIAL SCIENCES AT

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THE NIH.

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TWO YEARS AGO, THE NIH RELEASED

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A SET OF EXPERT PANEL

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RECOMMENDATIONS FOR THE AGENCY

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TO STRENGTHEN ITS PORTFOLIO IN

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BASIC RESEARCH IN THE BEHAVIORAL

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AND SOCIAL SCIENCES.

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THESE RECOMMENDATIONS INCLUDED

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EXPANDING OUR UNDERSTANDING OF

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CAUSAL INFERENCE BEYOND JUST

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RANDOMIZED CLINICAL TRIALS.

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OU -- PROJECTS IN THE LITERATURE

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AND RECOMMENDED WE HEAR FROM

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PROFESSOR JON WILLIAMSON.

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SO WE WELCOME HIM AS THE

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DISTINGUISHED LECTURER TO BEGIN

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OUR SERIES OF EXPANDING THE NIH

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COMMUNITY AND STAKEHOLDERS

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UNDERSTANDING WITH REGARD TO

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CAUSALITY.

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FOR FURTHER INTRODUCTION, I'LL

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TURN IT OVER TO DR. JAMES

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MALONEY, DIRECTOR OF THE OFFICE

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OF BASIC BEHAVIORAL AND SOCIAL

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SCIENCES AND ASSOCIATE DIRECTOR

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FOR THE SAME AT NIH.

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>> THANKS SO MUCH.

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>> IN LIEU OF HAVING A
BREAK

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DURING OUR TECHNICAL

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DIFFICULTIES, WELCOME, AND THANK

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YOU, JOSH, FOR YOUR OPENING

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REMARKS.

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I'M BILL ELWOOD FROM THE OFFICE

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OF SOCIAL -- BEHAVIORAL AND

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SOCIAL SCIENCES AT NIH, AND PART

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OF THE TEAM RESPONSIBLE FOR

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BRINGING YOU THIS EXCITING

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LECTURE.

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PROFESSOR JON WILLIAMSON IS AT

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THE UNIVERSITY OF KENT, WHERE HE

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WORKS IN THE PHILOSOPHY OF

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SCIENCE AND MEDICINE.

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THERE HE IS THE CO-DIRECTOR OF

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THE CENTER FOR REASONING AND A

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MEMBER OF THE THEORETICAL

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REASONING RESEARCH CLUSTER.

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HE WORKS IN THE PHILOSOPHY OF

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CAUSALITY, THE FOUNDATIONS OF

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PROBABILITY, DEDUCTIVE LOGIC AND

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THE USE OF CAUSALITY,

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PROBABILITY AND INFERENCE

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METHODS IN SCIENCE AND MEDICINE.

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AS JOSH TOLD YOU, THIS CONCEPT

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TEAM WAS REALLY IMPRESSED WITH

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THE SCOPE OF PROFESSOR

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WILLIAMSON'S WORK, AND WE

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APPRECIATE HIM JOINING US TODAY

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FOR OUR PLENARY LECTURE IN THIS

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SERIES.

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YOU'RE WELCOME TO ANSWER -- TO

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POSE QUESTIONS DURING JON'S TALK

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THROUGH THE VIDEOCAST FUNCTION

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IN YOUR SCREEN, BUT WE WILL TAKE

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THEM ONCE JON HAS FINISHED.

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THANKS SO MUCH FOR JOINING US,

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JON.

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TAKE IT AWAY.

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>> THANK YOU VERY MUCH FOR
THE

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KIND INTRODUCTION, BILL.

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IT'S A GREAT PLEASURE TO BE

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TALKING TO YOU TODAY.

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SO I AM INTERESTED IN PHILOSOPHY

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OF SCIENCE AND MEDICINE, AND MY

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KEY AREA OF RESEARCH HAS BEEN

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CAUSATION AND PROBABILITY IN

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SCIENCE AND MEDICINE.

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I'M GOING TO TALK TODAY ABOUT A

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NEW FRAMEWORK FOR CAUSAL

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INFERENCES IN THE HEALTH AND

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SOCIAL SCIENCES.

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SO FIRST OF ALL, I'LL INTRODUCE

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THE NEW FRAMEWORK, GIVE A

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GENERAL INTRODUCTION TO THE

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FRAMEWORK, I'LL EXPLAIN HOW THE

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NEW APPROACH RELATES TO OTHER

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APPROACHES, AND THEN I'LL LOOK

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AT HOW IT PROVIDES AN ACCOUNT OF

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EXTERNAL VALIDITY, SO

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EXTRAPOLATING A CAUSAL CLAIM

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FROM ONE CONTEXT TO ANOTHER

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CONTEXT.

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AND THEN FINALLY, I WILL LOOK IN

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A BIT MORE DETAIL AS TO HOW

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UNDER THIS NEW FRAMEWORK, ONE

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GOES AHEAD AND EVALUATES THE

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EFFECTIVENESS, FOR EXAMPLE, OF A

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HEALTH INTERVENTION.

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AND I'LL LOOK AT A CONTROVERSIAL

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EXAMPLE OF NAMELY THE MANDATES

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FOR FACE MASKS AND WHETHER

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THEY'RE EFFECTIVE AT REDUCING

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THE SPREAD AND REDUCING SYMPTOMS

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OF COVID-19.

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AND BY LOOKING IN DETAIL AT A

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CASE STUDY, WE'LL GET A SENSE OF

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HOW THIS NEW APPROACH WORKS IN

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PRACTICE.

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OKAY.

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SO FIRST OF ALL TO PROVIDE AN

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INTRODUCTION TO THE FRAMEWORK

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FOR CAUSAL INFERENCE, THIS

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FRAMEWORK IS CALLED EVIDENTIAL

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PLURALISM, AND I'LL EXPLAIN WHAT

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THIS MEANS FIRST OF ALL.

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THE GUIDING IDEA BEHIND

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EVIDENTIAL PLURALISM STEMS FROM

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THE PLATITUDE THAT WE'RE ALL

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TAUGHT AT A YOUNG AGE, NAMELY,

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CORRELATION IS NOT CAUSATION.

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WHEN YOU FIND A CORRELATION

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BETWEEN TWO VARIABLES, A AND B,

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CONDITIONAL POTENTIAL

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CONFOUNDING VARIABLES, THIS

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MIGHT BE DUE TO ONE OF A RANGE

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OF POSSIBLE EXPLANATIONS.

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ONLY ONE OF WHICH IS CAUSATION.

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THERE ARE A NUMBER OF OTHER

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POSSIBLE EXPLANATIONS FOR A

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CORRELATION.

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IT COULD BE DUE TO REVERSE

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CAUSATION, CONFOUNDING

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PERFORMANCE BIAS, DETECTION BIAS

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OR ANY OTHER KIND OF BIAS, SO

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THERE'S A REPOSITORY ON THE

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INTERNET THAT LISTS THE KINDS OF

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BIAS THAT STUDIES A PRONE TO AND

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I COUNTED 65 DIFFERENT KIND OF

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BIAS.

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SO MANY POSSIBLE EXPLANATIONS

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FOR THE CORRELATION.

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IT COULD BE BOUND TO SHEER

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CHANCE.

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IT COULD BE THAT THE RESEARCHERS

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HAVE BEEN FISHING FOR

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CORRELATIONS OR THERE COULD BE

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TEMPLE TRENDS IN THE DATA THAT

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ARE RESPONSIBLE FOR THE

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CORRELATION RATHER THAN A CAUSAL

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CONNECTION.

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OR MAYBE THE CORRELATION IS DUE

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TO SOME CONNECTION BUT IT'S NOT

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A CAUSAL CONNECTION.

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SO MAYBE THE TWO VARIABLES HAVE

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OVERLAPPING MEANING, FOR EXAM 

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EXAMPLE.

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OR THEY'RE CONNECTED LOGICALLY.

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OR BY SOME MATHEMATICAL

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RELATIONSHIP.

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THIS HAPPENS QUITE FREQUENTLY

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WHEN REAL DATA IS INVOLVED.

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SO WHAT PICKS OUT CAUSATION FROM

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SOME OF THESE OTHER EXPLANATIONS

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OF A CORRELATION?

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WELL, IF AGO.

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IS A CAUSE OF B, THEN THERE'S

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GOING TO BE SOME COMPLEX OF

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MECHANISMS THAT EXPLAINS

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INSTANCES OF B BY APPEALING TO

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INSTANCES OF A, AND THAT CAN

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ACCOUNT FOR THE MAGNITUDE OF THE

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OBSERVED CORRELATION.

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SO THE DISTINCTIVE FEATURE ABOUT

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CAUSATION IS THAT THERE'S ALWAYS

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SOME MECHANISM OR COMPLEX OF

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MECHANISMS THAT UNDERPIN

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CAUSATION.

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SO IN ORDER TO ESTABLISH

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CAUSATION, YOU NEED TO ESTABLISH

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TWO THINGS.

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NOT ONLY DO YOU NEED TO

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ESTABLISH CORRELATION,

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CONDITIONAL AND POTENTIAL

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CONFOUNDERS, BUT ALSO THE

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EXISTENCE OF A MECHANISM THAT

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CAN EXPLAIN THAT CORRELATION.

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AND THAT'S THE GUIDING IDEA

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BEHIND EVIDENTIAL PLURALISM.

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SO EVIDENTIAL PLURALISM IS

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PROBABLY BEST ENCAPSULATED BY

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THIS DIAGRAM.

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AT THE TOP OF THE DIAGRAM IS THE

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CLAIM THAT WE WANT TO SUPPORT,

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NAMELY CAUSATION.

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THIS IS ESTABLISHED BY

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ESTABLISHING THE EXISTENCE OF

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THE CORRELATION AND THE

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EXISTENCE OF A LINKING

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MECHANISM.

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NOW, THE BEST WAY TO ESTABLISH A

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CORRELATION IS TO PERFORM SOME

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ASSOCIATION STUDY, SO THIS IS A

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LARGE STATISTICAL STUDY THAT

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MEASURES A AND B TOGETHER,

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TOGETHER PERHAPS WITH POTENTIAL

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CONFOUNDERS, AND TRIES TO

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ESTIMATE THE EXTENT OF A

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CORRELATION BETWEEN CAUSE AND

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EFFECT.

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CERTAIN KINDS OF STUDY DESIGN

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ARE PARTICULARLY VALUED.

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FOR EXAMPLE, RANDOMIZED CONTROL

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TRIALS, BECAUSE RANDOMIZED

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CONTROL TRIALS CAN INDIRECTLY

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CONFIRM THE EXISTENCE OF A

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LINKING MECHANISM.

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AND THEY DO THIS BY REDUCING THE

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PROBABILITY THAT ANY OBSERVED

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CORRELATION IS DUE TO

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CONFOUNDING BY UNFORESEEN

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FACTORS.

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SO IT POSSIBLE TO GET INDIRECT

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EVIDENCE CONFIRMING THE

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EXISTENCE OF A LINKING MECHAN 

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MECHANISM.

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BUT THERE'S A MUCH MORE DIRECT

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WAY TO CONFIRM THE PRESENCE OF A

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LINKING MECHANISM, AND THAT'S TO

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HYPOTHESIZE FEATURES OF THE

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MECHANISM CONNECTING A TO B.

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NOW THESE FEATURES COULD BE

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INTERMEDIARY VARIABLES, THEY

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COULD BE ENTITIES THAT ARE

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INVOLVES IN THE MECHANISM OR

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ACTIVITY INVOLVED, OR

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ORGANIZATIONAL FEATURES OF THE

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MECHANISM.

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SO THERE ARE A WIDE VARIETY OF

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POSSIBLE MECHANISM FEATURES THAT

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COULD BE HYPOTHESIZED.

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AND THEN STUDIES THAT LOOK FOR

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THE PRESENCE OR ABSENCE OF THESE

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FEATURES ARE CLASSIFIED AS

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MECHANISTIC STUDIES BY

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EVIDENTIAL PLURALISM.

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AND SO A SECOND WAY TO CONFIRM

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THE EXISTENCE OF A MECHANISM IS

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HYPOTHESIZING MECHANISM FEATURES

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AND TESTING TO SEE WHETHER THOSE

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FEATURES ARE PRESENT.

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SO EVIDENTIAL PLURALISM APPEALS

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TO TWO KINDS OF STUDY, AN

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ASSOCIATION STUDY AND A

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MECHANISTIC STUDY.

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THESE AREN'T DETERMINED BY ANY

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PARTICULAR STUDY DESIGN.

263
00:09:27,291 --> 00:09:29,159
THESE ARE DIFFERENT ROLES THAT

264
00:09:29,159 --> 00:09:30,027
STUDIES TAKE.

265
00:09:30,027 --> 00:09:32,663
SO ASSOCIATION STUDIES ARE

266
00:09:32,663 --> 00:09:34,932
MEASURING CAUSE AND EFFECT

267
00:09:34,932 --> 00:09:36,400
TOGETHER, WHEREAS MECHANISTIC

268
00:09:36,400 --> 00:09:38,669
STUDIES ARE LOOKING AT A FINER

269
00:09:38,669 --> 00:09:40,637
GRAIN AT FEATURES OF THE

270
00:09:40,637 --> 00:09:43,140
MECHANISM THAT LINK THE CAUSE

271
00:09:43,140 --> 00:09:47,077
AND EFFECT.

272
00:09:47,077 --> 00:09:47,978
AND EVIDENTIAL PLURALISM INVOKES

273
00:09:47,978 --> 00:09:49,713
TWO KINDS OF PLEURALISM.

274
00:09:49,713 --> 00:09:50,914
IT SAYS IF YOU WANT TO ESTABLISH

275
00:09:50,914 --> 00:09:54,418
A CAUSAL CLAIM, YOU NEED TO

276
00:09:54,418 --> 00:09:55,085
ESTABLISH CORRELATION AND

277
00:09:55,085 --> 00:09:55,352
MECHANISM.

278
00:09:55,352 --> 00:09:58,255
THAT'S THE TOP PART OF THE

279
00:09:58,255 --> 00:10:00,657
DIAGRAM.

280
00:10:00,657 --> 00:10:01,925
SO IF YOU WANT TO ASSESS A

281
00:10:01,925 --> 00:10:03,293
CAUSAL CLAIM YOU NEED TO

282
00:10:03,293 --> 00:10:04,494
CONSIDER NOT ONLY ASSOCIATION

283
00:10:04,494 --> 00:10:06,129
STUDIES BUT ALSO MECHANISTIC

284
00:10:06,129 --> 00:10:08,198
STUDIES.

285
00:10:08,198 --> 00:10:10,834
AND THAT'S THE GUIDING IDEA

286
00:10:10,834 --> 00:10:17,174
BEHIND EVIDENTIAL PLURALISM.

287
00:10:17,174 --> 00:10:19,142
ONE IMPORTANT THING TO NOTE IS

288
00:10:19,142 --> 00:10:20,677
THAT EVIDENTIAL PLURALISM GOES

289
00:10:20,677 --> 00:10:23,513
AGAINST THE STANDARD TENETS OF

290
00:10:23,513 --> 00:10:25,282
EVIDENCE-BASED MEDICINE AND

291
00:10:25,282 --> 00:10:27,451
EVIDENCE-BASED POLICY.

292
00:10:27,451 --> 00:10:29,653
SO EVIDENCE-BASED MEDICINE WAS

293
00:10:29,653 --> 00:10:33,590
PUT FORWARD TO DE-EMPHASIZE THE

294
00:10:33,590 --> 00:10:36,760
ROLE OF MECHANISTIC EVIDENCE.

295
00:10:36,760 --> 00:10:39,296
SO WHEN IT WAS INTRODUCED, THE

296
00:10:39,296 --> 00:10:42,766
IDEA WAS TO PRIORITIZE

297
00:10:42,766 --> 00:10:43,967
RANDOMIZED CONTROL TRIALS,

298
00:10:43,967 --> 00:10:47,704
REVIEWS OF RANDOMIZED CONTROLLED

299
00:10:47,704 --> 00:10:49,773
TRIALS, AND FOCUS ON

300
00:10:49,773 --> 00:10:52,509
SCRUTINIZING THOSE KINDS OF

301
00:10:52,509 --> 00:10:54,578
STUDIES RATHER THAN OTHER KINDS

302
00:10:54,578 --> 00:10:56,680
OF OBSERVATIONAL STUDY WHICH ARE

303
00:10:56,680 --> 00:11:00,283
VIEWED AS INFERIOR TO RANDOMIZED

304
00:11:00,283 --> 00:11:03,220
CONTROL TRIALS, AND REALLY

305
00:11:03,220 --> 00:11:04,454
EVIDENCE-BASED MEDICINE, THE

306
00:11:04,454 --> 00:11:06,823
IDEA OF EVIDENCE-BASED MEDICINE

307
00:11:06,823 --> 00:11:10,794
IS TO SIDELINE IMPORTANT STUDY

308
00:11:10,794 --> 00:11:13,296
DESIGNS THAT CAN PRODUCE GOOD

309
00:11:13,296 --> 00:11:15,532
QUALITY EVIDENCE OF MECHANISM

310
00:11:15,532 --> 00:11:18,335
SUCH AS ANIMAL RESEARCH OR IN

311
00:11:18,335 --> 00:11:19,970
VITRO TEST TUBE RESEARCH.

312
00:11:19,970 --> 00:11:22,572
SO IN THIS EXAMPLE OF AN

313
00:11:22,572 --> 00:11:24,241
EVIDENCE HIERARCHY USED IN

314
00:11:24,241 --> 00:11:26,410
TEACHING EVIDENCE-BASED

315
00:11:26,410 --> 00:11:29,046
MEDICINE, ANIMAL RESEARCH AND IN

316
00:11:29,046 --> 00:11:30,180
VITRO RESEARCH ARE PUT RIGHT AT

317
00:11:30,180 --> 00:11:32,983
THE BOTTOM OF THE EVIDENCE

318
00:11:32,983 --> 00:11:36,053
HIERARCHY, BELOW EVEN IDEAS AND

319
00:11:36,053 --> 00:11:37,921
OPINIONS.

320
00:11:37,921 --> 00:11:40,624
AND A SYSTEMATIC REVIEW IN

321
00:11:40,624 --> 00:11:43,160
EVIDENCE-BASED MEDICINE OR

322
00:11:43,160 --> 00:11:44,461
EVIDENCE-BASED POLICY WON'T

323
00:11:44,461 --> 00:11:45,862
BOTHER SCRUTINIZING MECHANISTIC

324
00:11:45,862 --> 00:11:49,266
EVIDENCE.

325
00:11:49,266 --> 00:11:50,267
EVIDENTIAL PLURALISM IN CONTRAST

326
00:11:50,267 --> 00:11:52,135
WANTS TO TREAT MECHANISTIC

327
00:11:52,135 --> 00:11:54,304
EVIDENCE ON A PAR WITH

328
00:11:54,304 --> 00:11:58,141
ASSOCIATION STUDIES.

329
00:11:58,141 --> 00:11:59,776
SO EVIDENTIAL PLURALISM TAKES

330
00:11:59,776 --> 00:12:02,412
MECHANISTIC STUDIES TO BE OF

331
00:12:02,412 --> 00:12:03,714
EQUAL VALUE TO ASSOCIATION

332
00:12:03,714 --> 00:12:07,517
STUDIES.

333
00:12:07,517 --> 00:12:08,518
SO EVIDENTIAL PLURALISM

334
00:12:08,518 --> 00:12:09,619
ADVOCATES LOOKING AT THE KINDS

335
00:12:09,619 --> 00:12:12,789
OF STUDY THAT EVIDENCE-BASED

336
00:12:12,789 --> 00:12:16,727
MEDICINE LOOKS AT, SO THESE ARE

337
00:12:16,727 --> 00:12:19,563
REVIEWS, META ANALYSES, RCTs

338
00:12:19,563 --> 00:12:21,665
AND SO ON, BUT IT ALSO ADVOCATES

339
00:12:21,665 --> 00:12:22,733
LOOKING AT STUDIES THAT CAN

340
00:12:22,733 --> 00:12:25,268
EXPLORE FEATURES OF A LINKING

341
00:12:25,268 --> 00:12:26,903
MECHANISM BETWEEN CAUSE AND

342
00:12:26,903 --> 00:12:27,137
EFFECT.

343
00:12:27,137 --> 00:12:28,538
AND THIS MIGHT INCLUDE

344
00:12:28,538 --> 00:12:30,707
MANIPULATION STUDIES, SO IN

345
00:12:30,707 --> 00:12:33,910
VITRO STUDIES, OBSERVATIONAL

346
00:12:33,910 --> 00:12:36,213
STUDIES, BIOMEDICAL IMAGING, FOR

347
00:12:36,213 --> 00:12:37,080
EXAMPLE, CLINICAL STUDIES THAT

348
00:12:37,080 --> 00:12:39,416
LOOK FOR INTERMEDIARY VARIABLES,

349
00:12:39,416 --> 00:12:41,551
AND THIS COULD BE RANDOMIZED

350
00:12:41,551 --> 00:12:45,822
TRIALS, FOR EXAMPLE.

351
00:12:45,822 --> 00:12:48,558
CONFIRMED THEORY, FOR EXAMPLE,

352
00:12:48,558 --> 00:12:51,628
IMMUNOLOGICAL TH THEORY WOULD HP

353
00:12:51,628 --> 00:12:54,264
SUPPORT SPECIFIC MECHANISM

354
00:12:54,264 --> 00:12:55,132
HYPOTHESES, ANIMAL STUDIES CAN

355
00:12:55,132 --> 00:12:56,867
HELP AS WELL, AND SIMULATION

356
00:12:56,867 --> 00:12:58,301
STUDIES LIKE AGENT-BASED MODELS

357
00:12:58,301 --> 00:13:00,470
CAN ALSO BE HELPFUL IN TRYING TO

358
00:13:00,470 --> 00:13:02,906
UNDERSTAND FEATURES OF

359
00:13:02,906 --> 00:13:07,177
MECHANISMS.

360
00:13:07,177 --> 00:13:08,845
SO EVIDENCE-BASED MEDICINE AND

361
00:13:08,845 --> 00:13:10,113
EVIDENCE-BASED POLICY FOCUS ON

362
00:13:10,113 --> 00:13:12,315
THE LEFT SIDE OF THIS PICTURE,

363
00:13:12,315 --> 00:13:15,719
AND EVIDENTIAL PLURALISM IS

364
00:13:15,719 --> 00:13:17,654
SAYING STANDARD EVIDENCE-BASED

365
00:13:17,654 --> 00:13:18,655
MEDICINE, EVIDENCE-BASED POLICY

366
00:13:18,655 --> 00:13:20,323
IS ONLY HALF OF THE PICTURE' WE

367
00:13:20,323 --> 00:13:21,658
SHOULD BE LOOKING ALONGSIDE

368
00:13:21,658 --> 00:13:23,260
THESE KINDS OF STUDIES AT

369
00:13:23,260 --> 00:13:31,101
MECHANISTIC STUDIES.

370
00:13:31,101 --> 00:13:33,069
SO THE IDEAL CHAMPION BY

371
00:13:33,069 --> 00:13:34,504
EVIDENCE-BASED MEDICINE IS YOU

372
00:13:34,504 --> 00:13:35,372
FOCUS ON THE ASSOCIATION STUDIES

373
00:13:35,372 --> 00:13:37,474
AND IF ALL GOES WELL, THE

374
00:13:37,474 --> 00:13:40,177
ASSOCIATION STUDIES ARE GOING TO

375
00:13:40,177 --> 00:13:41,144
ESTABLISH NOT ONLY THE PRESENCE

376
00:13:41,144 --> 00:13:44,214
OF A CORRELATION BETWEEN THE TWO

377
00:13:44,214 --> 00:13:45,182
VARIABLES YOU'RE INTERESTED IN,

378
00:13:45,182 --> 00:13:46,283
BUT ALSO ESTABLISH THE PRESENCE

379
00:13:46,283 --> 00:13:49,920
OF A LINKING MECHANISM.

380
00:13:49,920 --> 00:13:52,289
AND IF YOU'VE GOT SEVERAL HIGH

381
00:13:52,289 --> 00:13:53,723
QUALITY RANDOMIZED CONTROLLED

382
00:13:53,723 --> 00:13:54,491
TRIALS, THAT CAN HAPPEN.

383
00:13:54,491 --> 00:13:55,926
ONCE YOU ESTABLISH THOSE TWO

384
00:13:55,926 --> 00:14:00,397
THINGS, YOU ESTABLISH CAUSATION.

385
00:14:00,397 --> 00:14:01,731
THAT'S THE IDEAL, BUT THE IDEAL

386
00:14:01,731 --> 00:14:03,834
IS RARELY BORNE OUT IN PRACTICE,

387
00:14:03,834 --> 00:14:06,403
AND THIS IS FOR TWO REASONS.

388
00:14:06,403 --> 00:14:08,138
THE FIRST IS THAT ASSOCIATION

389
00:14:08,138 --> 00:14:10,507
STUDIES ARE OFTEN NOT AS HIGH

390
00:14:10,507 --> 00:14:13,977
QUALITY AS THE IDEAL WOULD LIKE,

391
00:14:13,977 --> 00:14:17,581
AND IT'S OFTEN NOT THE CASE THAT

392
00:14:17,581 --> 00:14:18,982
THE ASSOCIATION STUDIES SUFFICE

393
00:14:18,982 --> 00:14:22,152
TO ESTABLISH CAUSATION.

394
00:14:22,152 --> 00:14:24,621
SECONDLY, IT'S NOT THE CASE IN,

395
00:14:24,621 --> 00:14:27,424
FOR EXAMPLE, DRUG APPROVAL

396
00:14:27,424 --> 00:14:30,927
MEETINGS OR OTHER EVALUATION

397
00:14:30,927 --> 00:14:32,329
MEETINGS THAT ASSOCIATION

398
00:14:32,329 --> 00:14:34,164
STUDIES EXHAUST THE EVIDENCE.

399
00:14:34,164 --> 00:14:35,298
TYPICALLY WE KNOW QUITE A LOT

400
00:14:35,298 --> 00:14:39,135
ABOUT MECHANISMS OF ACTION OF A

401
00:14:39,135 --> 00:14:40,971
DRUG, FOR EXAMPLE, OR OTHER

402
00:14:40,971 --> 00:14:41,872
KINDS OF INTERVENTIONS.

403
00:14:41,872 --> 00:14:44,374
AND THESE ARE USED TO GUIDE THE

404
00:14:44,374 --> 00:14:46,776
APPROVAL PROCESS, BUT IN A VERY

405
00:14:46,776 --> 00:14:50,013
UNSYSTEMATIC AND UNEXPLICIT WAY,

406
00:14:50,013 --> 00:14:51,047
IT OFTEN DEPENDS WHO'S AROUND

407
00:14:51,047 --> 00:14:53,350
THE TABLE AS TO WHAT MECHANISM

408
00:14:53,350 --> 00:14:55,085
HYPOTHESES GET DISCUSSED, AND

409
00:14:55,085 --> 00:14:58,588
THERE'S NO SERIOUS

410
00:14:58,588 --> 00:14:59,589
CONSIDERATION, SYSTEMATIC

411
00:14:59,589 --> 00:15:00,790
CONSIDERATION OF MECHANISTIC

412
00:15:00,790 --> 00:15:02,859
STUDIES.

413
00:15:02,859 --> 00:15:05,228
SO REALLY, THERE ARE TWO

414
00:15:05,228 --> 00:15:05,929
DEFICIENCIES IN THE STANDARD

415
00:15:05,929 --> 00:15:06,463
APPROACH.

416
00:15:06,463 --> 00:15:07,430
THE FIRST IS THAT IN THE

417
00:15:07,430 --> 00:15:09,399
BACKGROUND, THERE IS MECHANISTIC

418
00:15:09,399 --> 00:15:11,067
EVIDENCE GOING ON, AND THIS CAN

419
00:15:11,067 --> 00:15:14,237
SUPPORT OR UNDERMINE THE CAUSAL

420
00:15:14,237 --> 00:15:16,206
CLAIM, AND THE SECOND ISSUE IS

421
00:15:16,206 --> 00:15:18,942
THAT ASSOCIATION STUDIES ON

422
00:15:18,942 --> 00:15:22,112
THEIR OWN DON'T OFTEN SUFFICE TO

423
00:15:22,112 --> 00:15:28,018
ESTABLISH CAUSATION.

424
00:15:28,018 --> 00:15:30,520
SO LET'S CONSIDER A COUPLE OF

425
00:15:30,520 --> 00:15:31,721
EXAMPLES WHERE EVIDENCE OF

426
00:15:31,721 --> 00:15:35,525
MECHANISMS CAN CONFIRM CAUSAT 

427
00:15:35,525 --> 00:15:35,792
CAUSATION.

428
00:15:35,792 --> 00:15:37,294
THERE'S A TONGUE IN CHEEK

429
00:15:37,294 --> 00:15:39,930
EXAMPLE PUT FORWARD BY SMITH AND

430
00:15:39,930 --> 00:15:41,998
PELL IN 2003.

431
00:15:41,998 --> 00:15:45,068
THEY SAY PARACHUTES REDUCE THE

432
00:15:45,068 --> 00:15:48,571
RISK OF INJURY OF IMR GRAVITATIL

433
00:15:48,571 --> 00:15:49,539
CHALLENGE BUT THEIR

434
00:15:49,539 --> 00:15:50,540
EFFECTIVENESS HAS NOT BEEN

435
00:15:50,540 --> 00:15:52,642
PROVED WITH RANDOMIZED

436
00:15:52,642 --> 00:15:53,376
CONTROLLED TRIALS.

437
00:15:53,376 --> 00:15:54,811
OF COURSE WE'RE NOT GOING TO

438
00:15:54,811 --> 00:15:56,646
CONDUCT RANDOMIZED CONTROLLED

439
00:15:56,646 --> 00:15:59,282
TRIALS ON THE USE OF PARACHUTES.

440
00:15:59,282 --> 00:16:00,684
AND THE REASON WE'RE NOT GOING

441
00:16:00,684 --> 00:16:02,519
TO DO THIS IS BECAUSE WE'VE GOT

442
00:16:02,519 --> 00:16:04,888
VERY GOOD MECHANISTIC EVIDENCE

443
00:16:04,888 --> 00:16:10,760
AS TO HOW PA PARACHUTES WORK AND

444
00:16:10,760 --> 00:16:12,095
THAT IS VERY INFORMATIVE.

445
00:16:12,095 --> 00:16:13,964
SO IT SUFFICES TO HAVE

446
00:16:13,964 --> 00:16:14,931
UNSYSTEMATIC OBSERVATIONS OF THE

447
00:16:14,931 --> 00:16:18,535
USE OF PARACHUTES IN THE PAST,

448
00:16:18,535 --> 00:16:19,302
TOGETHER WITH MECHANISTIC

449
00:16:19,302 --> 00:16:21,271
EVIDENCE ABOUT HOW THEY WORK,

450
00:16:21,271 --> 00:16:25,175
AND WE ALL KNOW THAT PARACHUTE

451
00:16:25,175 --> 00:16:27,277
USE CAN REDUCE THE RISK OF

452
00:16:27,277 --> 00:16:28,611
INJURY WHEN FALLING FROM SUCH A

453
00:16:28,611 --> 00:16:31,348
HEIGHT.

454
00:16:31,348 --> 00:16:34,150
SO THEIR POINT WAS THAT REALLY

455
00:16:34,150 --> 00:16:37,921
THIS FOCUS ON -- EXCLUSIVE FOCUS

456
00:16:37,921 --> 00:16:42,392
ON ASSOCIATION STUDIES ISN'T THE

457
00:16:42,392 --> 00:16:44,995
WHOLE STORY.

458
00:16:44,995 --> 00:16:46,196
EVIDENCE-BASED EVALUATION SHOULD

459
00:16:46,196 --> 00:16:49,499
INVOLVE MORE THAN JUST

460
00:16:49,499 --> 00:16:53,003
RANDOMIZED CONTROL TRIALS.

461
00:16:53,003 --> 00:16:53,937
HERE'S A MORE SERIOUS EXAMPLE,

462
00:16:53,937 --> 00:16:59,009
AND THIS IS THE USE OF ECMO TO

463
00:16:59,009 --> 00:17:01,311
HELP WITH PERSISTENT PULMONARY

464
00:17:01,311 --> 00:17:02,512
HYPERTENSION.

465
00:17:02,512 --> 00:17:06,883
SO IF BABIES ARE BORN VERY

466
00:17:06,883 --> 00:17:07,884
PREMATURELY, SOMETIMES THEIR

467
00:17:07,884 --> 00:17:11,254
LUNGS CAN'T OXYGENATE THE BLOOD

468
00:17:11,254 --> 00:17:15,125
ADEQUATELY, AND SO ONE APPROACH

469
00:17:15,125 --> 00:17:17,727
IS DEALING WITH THIS IS TO

470
00:17:17,727 --> 00:17:19,195
OXYGENATE THE BLOOD OUTSIDE THE

471
00:17:19,195 --> 00:17:21,097
BODY UNTIL THE LUNGS ARE MATURE

472
00:17:21,097 --> 00:17:25,168
ENOUGH TO OPERATE ON THEIR OWN.

473
00:17:25,168 --> 00:17:26,903
AND THE ECCHYMOSIS TEM IS A

474
00:17:26,903 --> 00:17:28,038
MECHANISM FOR TAKING THE BLOOD

475
00:17:28,038 --> 00:17:31,941
FROM THE BODY, OXYGENATING IT

476
00:17:31,941 --> 00:17:33,576
AND PUTTING IT BACK INTO THE

477
00:17:33,576 --> 00:17:38,281
BODY, WHILE THE LUNGS DEVELOP.

478
00:17:38,281 --> 00:17:40,450
NOW, OBSERVATIONAL STUDIES

479
00:17:40,450 --> 00:17:41,651
SUGGESTED AN INCREASE IN

480
00:17:41,651 --> 00:17:44,821
SURVIVAL RATE FROM ABOUT 20% TO

481
00:17:44,821 --> 00:17:47,891
80%.

482
00:17:47,891 --> 00:17:49,426
BUT BECAUSE THE STANDARD

483
00:17:49,426 --> 00:17:51,728
EVIDENCE-BASED MEDICINE WAS THE

484
00:17:51,728 --> 00:17:53,897
NORM, IT WAS FELT NECESSARY TO

485
00:17:53,897 --> 00:17:57,634
CONDUCT RANDOMIZED CONTROL

486
00:17:57,634 --> 00:17:59,936
TRIALS, AND SO RANDOMIZED

487
00:17:59,936 --> 00:18:01,271
CONTROL TRIALS, I THINK SEVERAL

488
00:18:01,271 --> 00:18:04,541
TRIALS WERE CARRIED OUT, AND OF

489
00:18:04,541 --> 00:18:05,742
COURSE BABIES IN THE CONTROL

490
00:18:05,742 --> 00:18:07,043
GROUP DIED BECAUSE THEY WEREN'T

491
00:18:07,043 --> 00:18:13,917
GIVEN THE ECCHYMOSIS T ECMO SYSO

492
00:18:13,917 --> 00:18:14,584
OXYGENATE THEIR BLOOD.

493
00:18:14,584 --> 00:18:17,387
THIS IS A CASE WHERE PROGRAMS

494
00:18:17,387 --> 00:18:18,288
RANDOMIZED CONTROLLED TRIALS

495
00:18:18,288 --> 00:18:20,390
WERE COMPLETELY UNNECESSARY

496
00:18:20,390 --> 00:18:21,491
BECAUSE CAUSATION WAS ALREADY

497
00:18:21,491 --> 00:18:23,793
WELL ESTABLISHED BEFORE THE

498
00:18:23,793 --> 00:18:26,129
TRIAL STARTED, SO THERE WAS GOOD

499
00:18:26,129 --> 00:18:26,963
OBSERVATIONAL EVIDENCE

500
00:18:26,963 --> 00:18:30,133
SUGGESTING A VERY LARGE EFFECT

501
00:18:30,133 --> 00:18:31,534
SIZE, AN INCREASE IN SURVIVAL

502
00:18:31,534 --> 00:18:34,270
RATE FROM 20% TO 80%, AND THE

503
00:18:34,270 --> 00:18:36,573
MECHANISM WAS VERY WELL-KNOWN.

504
00:18:36,573 --> 00:18:38,508
LIKE THE PARACHUTE MECHANISM,

505
00:18:38,508 --> 00:18:40,844
IT'S CLEAR WHAT THE MECHANISM OF

506
00:18:40,844 --> 00:18:43,680
TREATMENT IS DOING HERE.

507
00:18:43,680 --> 00:18:45,315
AND SO THIS COULD BE A CASE IN

508
00:18:45,315 --> 00:18:49,919
WHICH ONE COULD ARGUE THAT

509
00:18:49,919 --> 00:18:51,121
REALLY THE TRIAL SHOULD NEVER

510
00:18:51,121 --> 00:18:52,989
HAVE BEEN CONDUCTED.

511
00:18:52,989 --> 00:18:55,525
SO WHAT'S GOING ON IN THESE

512
00:18:55,525 --> 00:18:56,392
EXAMPLES?

513
00:18:56,392 --> 00:18:59,662
WELL, YOU HAVE THE UNSYSTEMATIC

514
00:18:59,662 --> 00:19:00,964
OBSERVATIONAL DATA.

515
00:19:00,964 --> 00:19:03,032
THESE DON'T SUFFICE TO ESTABLISH

516
00:19:03,032 --> 00:19:04,567
CORRELATION ON THEIR OWN.

517
00:19:04,567 --> 00:19:06,870
THEY MAY BE SUPPORTED

518
00:19:06,870 --> 00:19:07,971
CORRELATION, BUT THEY DON'T

519
00:19:07,971 --> 00:19:09,506
SUFFICE TO ESTABLISH

520
00:19:09,506 --> 00:19:11,875
CORRELATION, NOR DO THEY SUFFICE

521
00:19:11,875 --> 00:19:13,109
TO ESTABLISH THE PRESENCE OF A

522
00:19:13,109 --> 00:19:13,977
LINKING MECHANISM.

523
00:19:13,977 --> 00:19:17,380
WHAT'S GOING ON HERE IS THAT WE

524
00:19:17,380 --> 00:19:20,483
CAN EASILY HI HYPOTHESIZE FEATUS

525
00:19:20,483 --> 00:19:25,355
OF THE PARACHUTE MECHANISM, THE

526
00:19:25,355 --> 00:19:26,990
ECMO MECHANISM AND WE CAN

527
00:19:26,990 --> 00:19:28,491
CONFIRM THOSE FEATURES.

528
00:19:28,491 --> 00:19:31,161
THESE DO ALLOW US TO ESTABLISH

529
00:19:31,161 --> 00:19:32,695
THE PRESENCE OF A LINKING

530
00:19:32,695 --> 00:19:33,796
MECHANISM AND SIGNIFICANTLY

531
00:19:33,796 --> 00:19:36,299
RAISE OUR CONFIDENCE THAT THE

532
00:19:36,299 --> 00:19:40,136
OBSERVED CORRELATION IS GOING TO

533
00:19:40,136 --> 00:19:41,538
PERSIST CONDITIONAL ON POTENTIAL

534
00:19:41,538 --> 00:19:41,838
CONFOUNDERS.

535
00:19:41,838 --> 00:19:43,406
AND THIS ALLOWS US TO ESTABLISH

536
00:19:43,406 --> 00:19:44,507
CAUSATION.

537
00:19:44,507 --> 00:19:47,777
SO THESE ARE KIND OF EXTREME

538
00:19:47,777 --> 00:19:49,412
EXAMPLES WHERE EVIDENCE OF

539
00:19:49,412 --> 00:19:52,482
MECHANISMS CAN HELP SUPPORT

540
00:19:52,482 --> 00:19:55,418
CAUSATION.

541
00:19:55,418 --> 00:19:57,086
EVIDENCE MECHANISMS CAN ALSO

542
00:19:57,086 --> 00:19:57,854
UNDERMINE CAUSATION.

543
00:19:57,854 --> 00:20:01,357
SO AGAIN, THERE ARE TONGUE IN

544
00:20:01,357 --> 00:20:04,427
CHEEK EXAMPLES, TESTING REMOTE

545
00:20:04,427 --> 00:20:06,796
RETROACTIVE INTERCESSIONARY

546
00:20:06,796 --> 00:20:08,998
PRAYER, FINDING IT IN A

547
00:20:08,998 --> 00:20:09,766
RANDOMIZED CONTROLLED TRIAL TO

548
00:20:09,766 --> 00:20:10,767
BE ASSOCIATED WITH LENGTH OF

549
00:20:10,767 --> 00:20:12,168
STAY OF PATIENTS IN HOSPITALS.

550
00:20:12,168 --> 00:20:15,238
SO THIS IS PRAYING FOR PATIENTS'

551
00:20:15,238 --> 00:20:17,740
RECOVERY AFTER THEY'VE LEFT

552
00:20:17,740 --> 00:20:19,275
HOSPITAL, AND THERE WAS AN

553
00:20:19,275 --> 00:20:20,476
OBSERVED CORRELATION BETWEEN THE

554
00:20:20,476 --> 00:20:22,545
LENGTH OF STAY OF PATIENTS IN

555
00:20:22,545 --> 00:20:23,980
HOSPITAL AND WHETHER THEY WERE

556
00:20:23,980 --> 00:20:27,717
PRAYED FOR SUBSEQUENTLY.

557
00:20:27,717 --> 00:20:30,053
THERE WERE RANDOMIZED CONTROLLED

558
00:20:30,053 --> 00:20:31,988
TRIALS THAT HAVE CONFIRMED

559
00:20:31,988 --> 00:20:33,556
PRECOG NIGMS, RANDOMIZED

560
00:20:33,556 --> 00:20:36,025
CONTROLLED TRIALS THAT CONFIRMED

561
00:20:36,025 --> 00:20:36,359
HOMEOPATHY.

562
00:20:36,359 --> 00:20:39,295
WE DON'T LEND THESE TRIALS VERY

563
00:20:39,295 --> 00:20:40,063
MUCH CREDENCE.

564
00:20:40,063 --> 00:20:41,397
WHY DON'T WE DO THAT?

565
00:20:41,397 --> 00:20:42,999
WELL, IT'S BECAUSE WE'VE GOT

566
00:20:42,999 --> 00:20:44,867
VERY STRONG NEGATIVE EVIDENCE OF

567
00:20:44,867 --> 00:20:46,402
MECHANISMS HERE.

568
00:20:46,402 --> 00:20:47,837
SO ALTHOUGH WE MIGHT HAVE A

569
00:20:47,837 --> 00:20:49,272
LITTLE SUPPORT FROM THESE TRIALS

570
00:20:49,272 --> 00:20:51,975
FOR A CORRELATION, EVIDENCE OF

571
00:20:51,975 --> 00:20:56,346
MECHANISMS IS UNDERMINING THIS

572
00:20:56,346 --> 00:20:58,548
SUPPORT.

573
00:20:58,548 --> 00:20:59,983
WE KNOW AS FAR AS OUR BEST

574
00:20:59,983 --> 00:21:02,919
SCIENCE TELLS US, ANY SPECIFIC

575
00:21:02,919 --> 00:21:04,320
MECHANISM HYPOTHESES THAT HAVE

576
00:21:04,320 --> 00:21:05,755
BEEN PUT FORWARD HAVE BEEN

577
00:21:05,755 --> 00:21:07,190
REJECTED, AND AS FAR AS WE KNOW,

578
00:21:07,190 --> 00:21:09,392
THERE'S NO MECHANISM LINKING A

579
00:21:09,392 --> 00:21:13,763
TO B IN THESE EXAMPLES.

580
00:21:13,763 --> 00:21:16,466
AND SO WE TEND TO RULE OUT

581
00:21:16,466 --> 00:21:19,769
CAUSATION IN THIS CASE.

582
00:21:19,769 --> 00:21:22,171
AGAIN, EVIDENTIAL PLURALISM CAN

583
00:21:22,171 --> 00:21:24,807
EXPLAIN OUR PATTERN OF REASONING

584
00:21:24,807 --> 00:21:27,410
HERE BY APPEALING TO MECHANISTIC

585
00:21:27,410 --> 00:21:31,581
EVIDENCE.

586
00:21:31,581 --> 00:21:33,116
SO EVIDENTIAL PLURALISM HAS BEEN

587
00:21:33,116 --> 00:21:35,752
APPLIED BOTH IN THE AREA OF

588
00:21:35,752 --> 00:21:38,087
MEDICINE, AND THIS LEADS TO AN

589
00:21:38,087 --> 00:21:39,889
APPROACH CALLED EBM+.

590
00:21:39,889 --> 00:21:43,493
SO THE PLUS HERE IS CONSIDERING

591
00:21:43,493 --> 00:21:46,562
MECHANISMS ALONGSIDE THE

592
00:21:46,562 --> 00:21:48,097
STANDARD METHODS OF EBM.

593
00:21:48,097 --> 00:21:50,400
SO I NEED TO EMPHASIZE THAT THIS

594
00:21:50,400 --> 00:21:53,136
ISN'T REJECTING THE STANDARD

595
00:21:53,136 --> 00:21:55,104
STUDIES THAT EBM LOOKS AT.

596
00:21:55,104 --> 00:21:57,607
IT SAYING THAT THE STANDARD

597
00:21:57,607 --> 00:21:58,441
STUDIES AREN'T ENOUGH ON THEIR

598
00:21:58,441 --> 00:21:58,941
OWN.

599
00:21:58,941 --> 00:22:01,978
WE ALSO NEED TO SYSTEMATICALLY

600
00:22:01,978 --> 00:22:03,146
SCRUTINIZE THE MECHANISTIC

601
00:22:03,146 --> 00:22:04,280
EVIDENCE THAT WE'VE GOT BECAUSE

602
00:22:04,280 --> 00:22:07,450
THAT CAN HELP SUPPORT OR

603
00:22:07,450 --> 00:22:11,287
UNDERMINE OUR CAUSAL CLAIMS.

604
00:22:11,287 --> 00:22:14,223
IN THE AREA OF THE SOCIAL

605
00:22:14,223 --> 00:22:16,326
SCIENCES, THERE'S AN ANALOGOUS

606
00:22:16,326 --> 00:22:18,594
APPROACH THAT DEALS WITH

607
00:22:18,594 --> 00:22:21,030
EVIDENCE-BASED POLICY CALLED

608
00:22:21,030 --> 00:22:24,100
EBP+, AND THIS ADVOCATES LOOKING

609
00:22:24,100 --> 00:22:25,835
AT EVIDENCE OF MECHANISMS

610
00:22:25,835 --> 00:22:27,270
ALONGSIDE ASSOCIATION STUDIES

611
00:22:27,270 --> 00:22:29,205
WHEN WE'RE TRYING TO EVALUATE

612
00:22:29,205 --> 00:22:30,773
WHETHER A POLICY INTERVENTION

613
00:22:30,773 --> 00:22:33,376
WORKS OR NOT.

614
00:22:33,376 --> 00:22:36,546
HERE ARE A COUPLE OF OPEN ACCESS

615
00:22:36,546 --> 00:22:38,414
BOOKS ON THESE TWO APPROACHES IF

616
00:22:38,414 --> 00:22:40,283
YOU'RE INTERESTED IN LEARNING

617
00:22:40,283 --> 00:22:45,955
MORE ABOUT THEM.

618
00:22:45,955 --> 00:22:46,622
OKAY.

619
00:22:46,622 --> 00:22:48,591
I'M NOW GOING TO MOVE ON TO SEE

620
00:22:48,591 --> 00:22:50,326
HOW EVIDENTIAL PLURALISM RELATES

621
00:22:50,326 --> 00:22:53,830
TO OTHER TECHNIQUES.

622
00:22:53,830 --> 00:22:56,566
SO WE'VE ALREADY SEEN THAT

623
00:22:56,566 --> 00:22:58,401
EVIDENCE-BASED MEDICINE,

624
00:22:58,401 --> 00:22:59,535
EVIDENCE-BASED POLICY FOCUSES ON

625
00:22:59,535 --> 00:23:00,937
THE LEFT-HAND SIDE OF THE

626
00:23:00,937 --> 00:23:05,541
CAUSATION DIAGRAM.

627
00:23:05,541 --> 00:23:07,410
THESE FOCUS PRETTY MUCH

628
00:23:07,410 --> 00:23:09,345
EXCLUSIVELY ON ASSOCIATION

629
00:23:09,345 --> 00:23:12,548
STUDIES, VIEW MECHANISTIC

630
00:23:12,548 --> 00:23:13,049
EVIDENCED INFERIOR TO

631
00:23:13,049 --> 00:23:14,183
ASSOCIATION STUDIES AND TEND NOT

632
00:23:14,183 --> 00:23:16,252
TO LOOK AT IT AT ALL WHEN

633
00:23:16,252 --> 00:23:19,856
CONDUCTING SYSTEMATIC REVIEWS.

634
00:23:19,856 --> 00:23:23,059
IN THE AREA OF EVIDENCE-BASED

635
00:23:23,059 --> 00:23:24,894
POLICY, THERE IS AN ALTERNATIVE

636
00:23:24,894 --> 00:23:28,164
APPROACH CALLED THEORY-BASED

637
00:23:28,164 --> 00:23:28,464
EVALUATION.

638
00:23:28,464 --> 00:23:32,201
AND THIS ENCOMPASSES A RANGE OF

639
00:23:32,201 --> 00:23:36,172
TECHNIQUES, INCLUDING REALIST

640
00:23:36,172 --> 00:23:38,808
EVALUATION TECHNIQUES AND

641
00:23:38,808 --> 00:23:39,642
CONTRIBUTION ANALYSIS.

642
00:23:39,642 --> 00:23:41,511
THESE TECHNIQUES TEND TO FOCUS

643
00:23:41,511 --> 00:23:44,380
ON THE RIGHT-HAND SIDE OF THE

644
00:23:44,380 --> 00:23:46,082
PICTURE AT THE EXCLUSION OF THE

645
00:23:46,082 --> 00:23:46,649
LEFT-HAND SIDE.

646
00:23:46,649 --> 00:23:49,819
SO THEORY-BASED EVALUATION WAS

647
00:23:49,819 --> 00:23:53,322
ORIGINALLY SUGGESTED BECAUSE OF

648
00:23:53,322 --> 00:23:54,957
DISSATISFACTION WITH EBM AND

649
00:23:54,957 --> 00:23:57,493
EBP, AND PUT FORWARD AS AN

650
00:23:57,493 --> 00:23:59,228
ALTERNATIVE APPROACH THAT

651
00:23:59,228 --> 00:24:04,934
FOCUSES ON MECHANISMS AND

652
00:24:04,934 --> 00:24:07,537
DOESN'T LIKE TO PURSUE THE SORT

653
00:24:07,537 --> 00:24:08,971
OF EXPERIMENTAL ASSOCIATION

654
00:24:08,971 --> 00:24:11,808
STUDY OF EVIDENCE-BASED MEDICINE

655
00:24:11,808 --> 00:24:13,576
AND EVIDENCE-BASED POLICY.

656
00:24:13,576 --> 00:24:15,244
SO EVIDENTIAL PLURALISM CAN BE

657
00:24:15,244 --> 00:24:23,519
THOUGHT OF AS COMBINING THE TECH

658
00:24:23,519 --> 00:24:24,720
TECHNIQUES OF EVIDENCE-BASED

659
00:24:24,720 --> 00:24:26,722
MEDICINE AND EVIDENCE-BASED

660
00:24:26,722 --> 00:24:29,425
POLICY ON ONE HAND AND THEORY ON

661
00:24:29,425 --> 00:24:30,860
THE OTHER, BUT INSTEAD OF

662
00:24:30,860 --> 00:24:33,930
REJECTING THE OTHER TECHNIQUES,

663
00:24:33,930 --> 00:24:35,765
TRYING TO BRING THEM TOGETHER IN

664
00:24:35,765 --> 00:24:38,167
ORDER TO EVALUATE ASSOCIATION

665
00:24:38,167 --> 00:24:40,269
STUDIES AND MECHANISTIC STUDIES

666
00:24:40,269 --> 00:24:46,375
ALONGSIDE ONE ANOTHER.

667
00:24:46,375 --> 00:24:47,910
IN THE SOCIAL SCIENCES, THERE'S

668
00:24:47,910 --> 00:24:49,779
BEEN A BIG DEBATE AMONGST

669
00:24:49,779 --> 00:24:52,181
RESEARCHERS AS TO WHETHER YOU

670
00:24:52,181 --> 00:24:56,352
SHOULD USE QUANTITATIVE EVIDENCE

671
00:24:56,352 --> 00:24:57,854
WHEN CONFIRMING YOUR CAUSAL

672
00:24:57,854 --> 00:25:03,893
CLAIMS, OR TO QUALITATIVE

673
00:25:03,893 --> 00:25:05,228
EVIDENCE/METHODS, AND RECENTLY,

674
00:25:05,228 --> 00:25:06,929
IN RECENT YEARS, MIXED METHODS

675
00:25:06,929 --> 00:25:09,799
RESEARCH HAS BEEN PUT FORWARD AS

676
00:25:09,799 --> 00:25:11,767
AND SORT OF COMPROMISED WHERE

677
00:25:11,767 --> 00:25:14,170
YOU APPEAL TO BOTH QUANTITATIVE

678
00:25:14,170 --> 00:25:15,671
AND QUALITATIVE METHODS TO HELP

679
00:25:15,671 --> 00:25:18,741
SUPPORT YOUR CONCLUSIONS.

680
00:25:18,741 --> 00:25:20,176
EVIDENTIAL PLURALISM CAN BE

681
00:25:20,176 --> 00:25:23,880
THOUGHT OF AS PROVIDING A

682
00:25:23,880 --> 00:25:24,981
GENERAL SUPPORT FOR MIXED

683
00:25:24,981 --> 00:25:28,284
METHODS RESEARCH, AND IT

684
00:25:28,284 --> 00:25:29,719
CONCEDES OF MIXED METHODS

685
00:25:29,719 --> 00:25:30,686
RESEARCH IN A CERTAIN SPECIFIC

686
00:25:30,686 --> 00:25:31,354
WAY.

687
00:25:31,354 --> 00:25:34,056
IT CONCEIVES OF QUANTITATIVE

688
00:25:34,056 --> 00:25:35,258
METHODS AS BEING METHODS THAT

689
00:25:35,258 --> 00:25:38,094
ARE TYPICALLY USED TO PRODUCE

690
00:25:38,094 --> 00:25:44,467
ASSOCIATION STUDIES, AND IS

691
00:25:44,467 --> 00:25:45,334
IMPORTANT INSOFAR AS THEY HAVE A

692
00:25:45,334 --> 00:25:47,904
ROLE IN PRODUCING ASSOCIATION

693
00:25:47,904 --> 00:25:49,972
STUDIES.

694
00:25:49,972 --> 00:25:52,041
BUT IT ALSO RECOGNIZES THE NEED

695
00:25:52,041 --> 00:25:54,043
FOR MECHANISTIC STUDIES AND

696
00:25:54,043 --> 00:25:55,444
MECHANISTIC STUDIES CAN BE

697
00:25:55,444 --> 00:25:57,547
EITHER QUANTITATIVE OR

698
00:25:57,547 --> 00:25:58,414
QUALITATIVE, AND IN PARTICULAR

699
00:25:58,414 --> 00:26:01,617
WHERE YOU DO HAVE HIGH QUALITY

700
00:26:01,617 --> 00:26:02,451
QUALITATIVE RESEARCH IS VERY

701
00:26:02,451 --> 00:26:04,554
IMPORTANT TO TAKE THAT INTO

702
00:26:04,554 --> 00:26:06,622
ACCOUNT, BECAUSE HIGH QUALITY

703
00:26:06,622 --> 00:26:08,925
QUALITATIVE RESEARCH CAN BE VERY

704
00:26:08,925 --> 00:26:13,296
INFORMATIVE WITH RESPECT TO

705
00:26:13,296 --> 00:26:14,730
FEATURES OF UNDERLYING

706
00:26:14,730 --> 00:26:16,132
MECHANISMS.

707
00:26:16,132 --> 00:26:17,133
SO EVIDENTIAL PLURALISM SAYS

708
00:26:17,133 --> 00:26:20,069
THAT WE DO NEED TO TAKE BOTH

709
00:26:20,069 --> 00:26:21,604
QUANTITATIVE AND QUALITATIVE

710
00:26:21,604 --> 00:26:22,705
METHODS INTO ACCOUNT, AND THE

711
00:26:22,705 --> 00:26:24,774
REASON WE NEED TO DO THIS IS

712
00:26:24,774 --> 00:26:27,710
BECAUSE WE NEED TO FOCUS ON

713
00:26:27,710 --> 00:26:29,478
ASSOCIATION STUDIES AND

714
00:26:29,478 --> 00:26:31,347
MECHANISTIC STUDIES.

715
00:26:31,347 --> 00:26:33,082
AND IT PROVIDES GUIDANCE AS TO

716
00:26:33,082 --> 00:26:34,717
HOW TO INTEGRATE OUR

717
00:26:34,717 --> 00:26:36,018
QUANTITATIVE AND QUALITATIVE

718
00:26:36,018 --> 00:26:36,752
EVIDENCE.

719
00:26:36,752 --> 00:26:38,220
WE STRUCTURE THIS INTEGRATION BY

720
00:26:38,220 --> 00:26:39,755
PUTTING FORWARD SPECIFIC

721
00:26:39,755 --> 00:26:43,159
MECHANISM HYPOTHESES, AND THEN

722
00:26:43,159 --> 00:26:45,094
SEEING HOW QUANTITATIVE AND

723
00:26:45,094 --> 00:26:46,762
QUALITATIVE STUDIES CONFIRM

724
00:26:46,762 --> 00:26:47,597
THESE HYPOTHESES.

725
00:26:47,597 --> 00:26:49,932
AND THAT FEEDS IN TO OUR

726
00:26:49,932 --> 00:26:55,938
JUDGMENTS ABOUT CAUSATION.

727
00:26:55,938 --> 00:26:57,707
CAUSAL MODELING TECHNIQUES CAN

728
00:26:57,707 --> 00:27:00,009
ALSO BE VIEWED AS PART OF THIS

729
00:27:00,009 --> 00:27:03,713
GENERAL PICTURE, SO MANY PEOPLE

730
00:27:03,713 --> 00:27:05,781
ADVOCATE FORMAL METHODS FOR

731
00:27:05,781 --> 00:27:07,383
CAUSAL MODELING SUCH AS

732
00:27:07,383 --> 00:27:10,920
GRAPHICAL CAUSAL MODELS OR

733
00:27:10,920 --> 00:27:13,022
STRUCTURAL EQUATION MODELS OR

734
00:27:13,022 --> 00:27:14,991
MODELS THAT APPEAL TO

735
00:27:14,991 --> 00:27:16,892
DIFFERENTIAL EQUATIONS, FOR

736
00:27:16,892 --> 00:27:20,229
EXAMPLE.

737
00:27:20,229 --> 00:27:21,964
THESE CAN BE VIEWED AS

738
00:27:21,964 --> 00:27:23,499
FORMALISMS FOR PUTTING FORWARD

739
00:27:23,499 --> 00:27:25,468
SPECIFIC MECHANISM HYPOTHESES.

740
00:27:25,468 --> 00:27:28,537
SO THESE CONNECT THE PUTATIVE

741
00:27:28,537 --> 00:27:31,073
CAUSE AND EFFECT TO INTERMEDIARY

742
00:27:31,073 --> 00:27:32,141
VARIABLES, PERHAPS ALONG

743
00:27:32,141 --> 00:27:36,078
MULTIPLE PATHWAYS.

744
00:27:36,078 --> 00:27:37,747
AND CONFIRMING THESE MODELS CAN

745
00:27:37,747 --> 00:27:39,015
HELP CONFIRM CAUSATION BECAUSE

746
00:27:39,015 --> 00:27:40,416
THEY HELP TO TELL US THAT

747
00:27:40,416 --> 00:27:42,752
THERE'S A MECHANISM LINKING THE

748
00:27:42,752 --> 00:27:43,953
PUTATIVE CAUSE TO PUTATIVE

749
00:27:43,953 --> 00:27:48,124
EFFECT.

750
00:27:48,124 --> 00:27:49,425
SO THESE SORTS OF MODELING

751
00:27:49,425 --> 00:27:50,593
TECHNIQUES CAN PLAY AN IMPORTANT

752
00:27:50,593 --> 00:27:53,362
ROLE IN OUR CAUSAL INFERENCES.

753
00:27:53,362 --> 00:27:55,564
OF COURSE ANY FORMALISM FOR

754
00:27:55,564 --> 00:28:00,036
CAUSAL MODELING WILL MAKE STRONG

755
00:28:00,036 --> 00:28:02,872
ASSUMPTIONS, AND THESE ALSO NEED

756
00:28:02,872 --> 00:28:03,873
TO BE VALIDATED.

757
00:28:03,873 --> 00:28:05,708
BUT ONCE THAT'S BORNE IN MIND,

758
00:28:05,708 --> 00:28:07,910
THEY CAN PLAY A VERY USEFUL

759
00:28:07,910 --> 00:28:16,118
ROLE.

760
00:28:16,118 --> 00:28:17,553
OKAY, SO I HAVE PROVIDED A

761
00:28:17,553 --> 00:28:18,154
GENERAL INTRODUCTION TO

762
00:28:18,154 --> 00:28:18,854
EVIDENTIAL PLURALISM AND I'VE

763
00:28:18,854 --> 00:28:20,389
TALKED A BIT ABOUT HOW IT RELATE

764
00:28:20,389 --> 00:28:22,358
TO OTHER APPROACHES.

765
00:28:22,358 --> 00:28:25,094
I'M NOW GOING TO MOVE ON TO THE

766
00:28:25,094 --> 00:28:27,997
QUESTION OF EXTERNAL V VALIDITY

767
00:28:27,997 --> 00:28:30,666
AND HOW IT CAPTURES

768
00:28:30,666 --> 00:28:31,967
EXTRAPOLATING FROM ONE

769
00:28:31,967 --> 00:28:33,502
POPULATION TO ANOTHER, AND THEN

770
00:28:33,502 --> 00:28:36,672
WE'LL LOOK AT A SPECIFIC CASE

771
00:28:36,672 --> 00:28:38,774
STUDY THAT SHOWS US HOW TO

772
00:28:38,774 --> 00:28:40,176
EVALUATE EFFECTIVENESS USING

773
00:28:40,176 --> 00:28:45,314
EVIDENTIAL PLURALISM.

774
00:28:45,314 --> 00:28:47,283
SO NEXT UP, EXTERNAL VALIDITY,

775
00:28:47,283 --> 00:28:49,151
HOW DO WE EXTRAPOLATE FROM ONE

776
00:28:49,151 --> 00:28:52,655
POPULATION TO ANOTHER.

777
00:28:52,655 --> 00:28:53,956
ACCORDING TO EVIDENTIAL

778
00:28:53,956 --> 00:28:55,391
PLURALISM, IF YOU'VE GOT A

779
00:28:55,391 --> 00:28:58,127
SOURCE POPULATION AND YOU CAN

780
00:28:58,127 --> 00:28:59,361
ESTABLISH CAUSATION ON THE

781
00:28:59,361 --> 00:29:02,932
SOURCE POPULATION, THEN THAT CAN

782
00:29:02,932 --> 00:29:05,968
HELP CONFIRM YOUR CAUSAL CLAIM

783
00:29:05,968 --> 00:29:11,140
ON THE TARGET POPULATION AS LONG

784
00:29:11,140 --> 00:29:12,141
AS YOU CAN PROVIDE SOME EVIDENCE

785
00:29:12,141 --> 00:29:14,110
THAT THE MECHANISMS OF ACTION ON

786
00:29:14,110 --> 00:29:16,178
THE SOURCE POPULATION ARE

787
00:29:16,178 --> 00:29:17,813
SIMILAR ENOUGH TO THE MECHANISMS

788
00:29:17,813 --> 00:29:19,348
OF ACTION ON THE TARGET

789
00:29:19,348 --> 00:29:22,184
POPULATION.

790
00:29:22,184 --> 00:29:25,688
SO HERE YOU CAN THINK OF STUDIES

791
00:29:25,688 --> 00:29:27,857
ON ONE COUNTRY AND WANTING TO

792
00:29:27,857 --> 00:29:30,726
EXTRAPOLATE YOUR CAUSAL CLAIM TO

793
00:29:30,726 --> 00:29:33,129
ANOTHER COUNTRY, OR YOU CAN

794
00:29:33,129 --> 00:29:35,865
THINK OF, FOR EXAMPLE, STUDIES

795
00:29:35,865 --> 00:29:37,266
OF MEDICINE ON MICE, AND YOU

796
00:29:37,266 --> 00:29:40,770
WANT TO EXTRAPOLATE YOUR

797
00:29:40,770 --> 00:29:44,507
CONCLUSIONS TO HELP CONFIRM

798
00:29:44,507 --> 00:29:50,613
CAUSATION IN HUMANS.

799
00:29:50,613 --> 00:29:53,349
NOW, TYPICALLY EVIDENCE-BASED

800
00:29:53,349 --> 00:29:56,952
MEDICINE STRUGGLES TO PREHENCE

801
00:29:56,952 --> 00:29:59,822
LIFL UNDERSTAND THE PROCESS OF

802
00:29:59,822 --> 00:30:02,324
EXTRAPOLATION, AND THIS LEADS

803
00:30:02,324 --> 00:30:03,526
MANY PROPONENTS OF

804
00:30:03,526 --> 00:30:05,394
EVIDENCE-BASED MEDICINE TO BE

805
00:30:05,394 --> 00:30:06,495
RATHER SKEPTICAL ABOUT THESE

806
00:30:06,495 --> 00:30:08,564
SORTS OF EXTRAPOLATION

807
00:30:08,564 --> 00:30:08,898
PROCESSES.

808
00:30:08,898 --> 00:30:10,432
SHOULD WE BE USING ANIMAL

809
00:30:10,432 --> 00:30:13,469
STUDIES AT ALL TO INFLUENCE OUR

810
00:30:13,469 --> 00:30:17,106
JUDGMENTS OF CAUSATION IN HUM 

811
00:30:17,106 --> 00:30:17,339
HUMANS?

812
00:30:17,339 --> 00:30:20,609
BUT THERE ARE CLEAR CASES WHERE

813
00:30:20,609 --> 00:30:23,112
STUDIES ON ANIMALS CAN CONFIRM

814
00:30:23,112 --> 00:30:27,049
CAUSATION IN HUMANS, AND THIS

815
00:30:27,049 --> 00:30:28,584
APPROACH KNOWN IN THE

816
00:30:28,584 --> 00:30:30,419
PHILOSOPHICAL LITERATURE IS

817
00:30:30,419 --> 00:30:32,087
MECHANISM-BASED EXTRAPOLATION

818
00:30:32,087 --> 00:30:33,489
HELPS US TO UNDERSTAND HOW

819
00:30:33,489 --> 00:30:35,024
THAT'S POSSIBLE.

820
00:30:35,024 --> 00:30:36,892
BECAUSE IF YOU CAN ESTABLISH

821
00:30:36,892 --> 00:30:38,194
CAUSATION ON A SOURCE POPULATION

822
00:30:38,194 --> 00:30:40,930
AND YOU KNOW THE MECHANISMS WORK

823
00:30:40,930 --> 00:30:42,798
SIMILARLY IN THE TARGET

824
00:30:42,798 --> 00:30:44,233
POPULATION, THEN THAT IS BOUND

825
00:30:44,233 --> 00:30:45,968
TO CONFIRM CAUSATION ON THE

826
00:30:45,968 --> 00:30:50,906
TARGET POPULATION.

827
00:30:50,906 --> 00:30:54,410
AND YOU CAN COMBINE THIS APPEAL

828
00:30:54,410 --> 00:30:56,145
TO SOURCE STUDIES, THAT IS,

829
00:30:56,145 --> 00:30:57,780
STUDIES CARRIED OUT ON A

830
00:30:57,780 --> 00:31:00,382
DIFFERENT SOURCE POPULATION,

831
00:31:00,382 --> 00:31:02,551
WITH THE GENERAL PICTURE OF

832
00:31:02,551 --> 00:31:04,019
EVIDENTIAL PLURALISM THAT

833
00:31:04,019 --> 00:31:05,421
APPEALS TO ASSOCIATION STUDIES

834
00:31:05,421 --> 00:31:06,889
AND MECHANISTIC STUDIES IN THE

835
00:31:06,889 --> 00:31:10,926
TARGET POPULATION, AND YOU CAN

836
00:31:10,926 --> 00:31:12,962
ENRICH THE PICTURE THAT

837
00:31:12,962 --> 00:31:16,365
EVIDENTIAL PLURALISM PROVIDES BY

838
00:31:16,365 --> 00:31:18,667
TAKING THESE SOURCE STUDIES INTO

839
00:31:18,667 --> 00:31:21,170
ACCOUNT ALONGSIDE ASSOCIATION

840
00:31:21,170 --> 00:31:24,039
STUDIES AND MECHANISTIC STUDIES.

841
00:31:24,039 --> 00:31:25,140
AND TOGETHER, THEY CAN HELP

842
00:31:25,140 --> 00:31:28,277
PROVIDE A SOLID BASIS FOR

843
00:31:28,277 --> 00:31:33,782
JUDGMENTS ABOUT CAUSATION.

844
00:31:33,782 --> 00:31:36,719
TO GIVE AN EXAMPLE OF AN

845
00:31:36,719 --> 00:31:37,720
ORGANIZATION THAT DOES THIS VERY

846
00:31:37,720 --> 00:31:41,190
WELL, I THINK, CONSIDER THE

847
00:31:41,190 --> 00:31:41,957
INTERNATIONAL AGENCY FOR

848
00:31:41,957 --> 00:31:44,260
RESEARCH ON CANCER.

849
00:31:44,260 --> 00:31:47,229
SO IARC IS A WORLD HEALTH

850
00:31:47,229 --> 00:31:49,932
ORGANIZATION BODY THAT EVALUATES

851
00:31:49,932 --> 00:31:52,468
THE CARCINOGENICITY OF VARIOUS

852
00:31:52,468 --> 00:31:54,536
SUBSTANCES OR ACTIVITIES THAT WE

853
00:31:54,536 --> 00:31:57,640
MIGHT BE EXPOSED TO AS WORKERS

854
00:31:57,640 --> 00:32:00,576
OR IN OUR DAILY LIFE.

855
00:32:00,576 --> 00:32:03,946
HOW DO THEY ASSESS WHETHER AN

856
00:32:03,946 --> 00:32:06,248
AGENT IS CARCINOGENIC IN HUMANS?

857
00:32:06,248 --> 00:32:10,286
WELL, THEY HAVE SUBGROUPS OF

858
00:32:10,286 --> 00:32:12,254
THEIR EVALUATION WORKING GROUP

859
00:32:12,254 --> 00:32:14,990
THAT LOOK AT DIFFERENT KINDS OF

860
00:32:14,990 --> 00:32:17,092
STUDIES.

861
00:32:17,092 --> 00:32:18,928
SO ONE SUBGROUP FOCUSES

862
00:32:18,928 --> 00:32:20,896
EXCLUSIVELY ON HUMAN

863
00:32:20,896 --> 00:32:22,097
EPIDEMIOLOGICAL STUDIES, SO

864
00:32:22,097 --> 00:32:26,802
STUDIES CARRIED OUT ON HUMANS

865
00:32:26,802 --> 00:32:29,238
MEASURING EXPOSURE TO THE

866
00:32:29,238 --> 00:32:31,740
POTENTIAL CARCINOGEN AND

867
00:32:31,740 --> 00:32:32,508
OCCURRENCE OF CANCER.

868
00:32:32,508 --> 00:32:34,043
SO THIS PLAYS THE ROLE OF

869
00:32:34,043 --> 00:32:35,644
ASSOCIATION STUDIES IN THE

870
00:32:35,644 --> 00:32:40,582
TARGET POPULATION.

871
00:32:40,582 --> 00:32:42,017
ANOTHER SUBGROUP FOCUSES

872
00:32:42,017 --> 00:32:43,552
ENTIRELY ON MECHANISTIC STUDIES

873
00:32:43,552 --> 00:32:48,257
AND LOOKS TO SEE WHETHER KEY

874
00:32:48,257 --> 00:32:49,758
FEATURES IN CANCER MECHANISMS

875
00:32:49,758 --> 00:32:51,093
ARE PRESENT IN CASE OF EXPOSURE

876
00:32:51,093 --> 00:32:53,595
TO THE AGENT IN QUESTION.

877
00:32:53,595 --> 00:32:55,464
AND IARC HAVE A LIST OF 10 KEY

878
00:32:55,464 --> 00:32:58,200
CHARACTERISTICS OF CANCER THAT

879
00:32:58,200 --> 00:32:59,335
THEY USE TO STRUCTURE THIS PART

880
00:32:59,335 --> 00:33:02,271
OF THE EVALUATION, AND THEY LOOK

881
00:33:02,271 --> 00:33:04,873
TO SEE WHETHER -- WHICH OF THESE

882
00:33:04,873 --> 00:33:06,842
10 FEATURES ARE PRESENT AND IF

883
00:33:06,842 --> 00:33:08,277
SEVERAL OF THESE FEATURES ARE

884
00:33:08,277 --> 00:33:11,313
PRESENT, THEN THAT CAN PROVIDE

885
00:33:11,313 --> 00:33:13,415
STRONG EVIDENCE THAT THERE'S A

886
00:33:13,415 --> 00:33:14,917
MECHANISM FROM THE AGENT TO

887
00:33:14,917 --> 00:33:18,854
CANCER IN HUMANS.

888
00:33:18,854 --> 00:33:19,989
A THIRD SUBGROUP OF THEIR

889
00:33:19,989 --> 00:33:21,190
WORKING GROUP WILL LOOK AT

890
00:33:21,190 --> 00:33:22,691
ANIMAL STUDY, MAYBE STUDIES

891
00:33:22,691 --> 00:33:26,328
CARRIED OUT IN MICE OR RATS, FOR

892
00:33:26,328 --> 00:33:29,798
EXAMPLE, AND AS LONG AS THERE'S

893
00:33:29,798 --> 00:33:31,567
EVIDENCE OF SIMILARITY OF THE

894
00:33:31,567 --> 00:33:33,535
UNDERLYING MECHANISMS, THIS WILL

895
00:33:33,535 --> 00:33:36,138
HELP INFORM JUDGMENTS OF

896
00:33:36,138 --> 00:33:38,774
CAUSATION.

897
00:33:38,774 --> 00:33:40,209
THE OVERALL WORKING GROUP, WHEN

898
00:33:40,209 --> 00:33:41,977
IT MEETS TOGETHER, WILL APPEAL

899
00:33:41,977 --> 00:33:47,649
TO THESE ANIMAL STUDIES TO HELP

900
00:33:47,649 --> 00:33:48,617
EVALUATE CARCINOGENICITY IN

901
00:33:48,617 --> 00:33:49,718
HUMANS.

902
00:33:49,718 --> 00:33:50,586
SO EVIDENTIAL PLURALISM PROVIDES

903
00:33:50,586 --> 00:33:55,524
A NICE UNDERSTANDING OF HOW IARC

904
00:33:55,524 --> 00:33:58,594
WORKS, AND IARC PROVIDES A NICE

905
00:33:58,594 --> 00:34:01,163
PRACTICAL EXAMPLE OF HOW

906
00:34:01,163 --> 00:34:03,732
EVIDENTIAL PLURALISM CAN WORK IN

907
00:34:03,732 --> 00:34:05,467
PRACTICE.

908
00:34:05,467 --> 00:34:07,736
SO IARC HAVE EVALUATED WELL OVER

909
00:34:07,736 --> 00:34:08,637
A THOUSAND DIFFERENT AGENTS

910
00:34:08,637 --> 00:34:11,607
USING THIS SORT OF APPROACH, AND

911
00:34:11,607 --> 00:34:12,574
ITS CONCLUSIONS HAVE TURNED OUT

912
00:34:12,574 --> 00:34:14,209
TO BE VERY ROBUST.

913
00:34:14,209 --> 00:34:17,146
SO WE'VE GOT GOOD EVIDENCE THAT

914
00:34:17,146 --> 00:34:20,015
EVIDENTIAL PLURALISM CAN WORK IN

915
00:34:20,015 --> 00:34:24,286
PRACTICE.

916
00:34:24,286 --> 00:34:27,022
ITS PRACTICABLE APPROACH.

917
00:34:27,022 --> 00:34:29,191
AND WE CAN CARRY IT OUT IN A

918
00:34:29,191 --> 00:34:32,694
SYSTEMATIC WAY.

919
00:34:32,694 --> 00:34:34,229
IARC HAVE LOOKED AT A NUMBER OF

920
00:34:34,229 --> 00:34:39,068
AGENTS IN A NUMBER OF CASES,

921
00:34:39,068 --> 00:34:40,469
MECHANISTIC EVIDENCE HAS BEEN

922
00:34:40,469 --> 00:34:42,871
ABSOLUTELY CRUCIAL TO HELPING TO

923
00:34:42,871 --> 00:34:44,206
ASSESS CAUSATION.

924
00:34:44,206 --> 00:34:48,811
SO FOR EXAMPLE, WITH SIMEON

925
00:34:48,811 --> 00:34:50,446
VIRUS, THERE WAS ANIMAL

926
00:34:50,446 --> 00:34:51,847
EVIDENCE, THERE WAS INADEQUATE

927
00:34:51,847 --> 00:34:54,049
HUMAN EVIDENCE, BUT THERE WAS

928
00:34:54,049 --> 00:34:55,818
EVIDENCE THAT THE MECHANISM OF

929
00:34:55,818 --> 00:34:57,453
TRANSFORMATION IN THESE ANIMAL

930
00:34:57,453 --> 00:35:00,289
STUDIES IS NOT OPERATING IN

931
00:35:00,289 --> 00:35:03,192
HUMANS, SO THAT MECHANISM

932
00:35:03,192 --> 00:35:07,930
EVIDENCE UNDER IT UNDERMINDING E

933
00:35:07,930 --> 00:35:10,132
EXTRAPOLATION FROM ANIMALS TO

934
00:35:10,132 --> 00:35:17,339
HUMANS.

935
00:35:17,339 --> 00:35:21,276
THERE WAS ULTIMATELY NO GOOD

936
00:35:21,276 --> 00:35:24,446
EVIDENCE OF CARCINOGENICITY.

937
00:35:24,446 --> 00:35:25,981
IN MANY OTHER CASE WHERE THERE'S

938
00:35:25,981 --> 00:35:26,949
BEEN ADEQUATE OR LIMITED

939
00:35:26,949 --> 00:35:31,620
EVIDENCE IN HUMANS, THERE'S BEEN

940
00:35:31,620 --> 00:35:32,821
STRONG EVIDENCE THAT SOME OF

941
00:35:32,821 --> 00:35:35,190
THESE KEY CHARACTERISTICS OF

942
00:35:35,190 --> 00:35:36,992
CANCER ARE PRESENT, SO THESE ARE

943
00:35:36,992 --> 00:35:38,293
THE SPECIFIC MECHANISM

944
00:35:38,293 --> 00:35:38,861
HYPOTHESES.

945
00:35:38,861 --> 00:35:44,967
AND THESE HAVE HELPED LEAD TO

946
00:35:44,967 --> 00:35:47,503
EVALUATIONS THAT CARCINOGENS ARE

947
00:35:47,503 --> 00:35:48,904
PROBABLY CARCINOGENIC OR

948
00:35:48,904 --> 00:35:51,740
POSSIBLY CARCINOGENIC IN HUMANS.

949
00:35:51,740 --> 00:35:59,948
SO THEY HELP BOOST CONFIRMATION

950
00:35:59,948 --> 00:36:01,383
IN CAUSATION.

951
00:36:01,383 --> 00:36:03,352
TO CLOSE OFF, I'M GOING TO LOOK

952
00:36:03,352 --> 00:36:07,489
NOW AT HOW WE WOULD EVALUATE

953
00:36:07,489 --> 00:36:08,457
EFFECTIVENESS USING EVIDENTIAL

954
00:36:08,457 --> 00:36:09,424
PLURALISM SO I'LL JUST RUN

955
00:36:09,424 --> 00:36:10,559
THROUGH AN EXAMPLE.

956
00:36:10,559 --> 00:36:14,596
THIS IS MOTIVATED BY SOME

957
00:36:14,596 --> 00:36:16,465
DISCUSSION ABOUT THE ROLE OF

958
00:36:16,465 --> 00:36:17,232
EVIDENCE-BASED MEDICINE IN THE

959
00:36:17,232 --> 00:36:17,766
PANDEMIC.

960
00:36:17,766 --> 00:36:19,301
SO SOME PEOPLE HAVE ARGUED THAT

961
00:36:19,301 --> 00:36:20,836
EVIDENCE-BASED MEDICINE DIDN'T

962
00:36:20,836 --> 00:36:22,704
PERFORM VERY WELL DURING THE

963
00:36:22,704 --> 00:36:24,373
COVID PANDEMIC.

964
00:36:24,373 --> 00:36:26,441
AND WE WOULD HAVE DONE BETTER

965
00:36:26,441 --> 00:36:28,210
WITH EVIDENCE-BASED MEDICINE

966
00:36:28,210 --> 00:36:30,913
PLUS.

967
00:36:30,913 --> 00:36:33,615
SO GREENHALGH AND OTHERS HAVE

968
00:36:33,615 --> 00:36:34,850
ARGUED, FOR EXAMPLE, THAT FOR

969
00:36:34,850 --> 00:36:36,818
SOME ASPECTS OF THE PANDEMIC,

970
00:36:36,818 --> 00:36:38,020
ESPECIALLY THOSE CHARACTERIZED

971
00:36:38,020 --> 00:36:41,857
BY A COMBINATION OF COMPLEXITY,

972
00:36:41,857 --> 00:36:45,227
URGENCY, AND THREAT, MECHANISTIC

973
00:36:45,227 --> 00:36:46,895
EVIDENCE HAS BEEN

974
00:36:46,895 --> 00:36:48,630
MISSION-CRITICAL AND RCTs

975
00:36:48,630 --> 00:36:50,732
DIFFICULT OR IMPOSSIBLE.

976
00:36:50,732 --> 00:36:52,267
THOUSANDS OF LIVES WERE LIKELY

977
00:36:52,267 --> 00:36:53,468
LOST AS A RESULT OF WHAT WAS

978
00:36:53,468 --> 00:36:55,437
INCORRECTLY CLAIMED TO BE AN

979
00:36:55,437 --> 00:36:59,274
EVIDENCE-BASED APPROACH.

980
00:36:59,274 --> 00:37:01,443
DISMISSING OR DOWNGRADING

981
00:37:01,443 --> 00:37:02,444
MECHANISTIC EVIDENCE,

982
00:37:02,444 --> 00:37:04,746
OVERVALUING FINDINGS FROM POORLY

983
00:37:04,746 --> 00:37:07,149
DESIGNED OR IRRELEVANT RCTs,

984
00:37:07,149 --> 00:37:08,784
AND ADVOCATING FOR INACTION

985
00:37:08,784 --> 00:37:12,421
WHERE RCT EVIDENCE WAS LACKING.

986
00:37:12,421 --> 00:37:14,489
THE PANDEMIC IS AN EP STE MIBG

987
00:37:14,489 --> 00:37:16,058
OPPORTUNITY FOR THE EBM MOVEMENT

988
00:37:16,058 --> 00:37:17,526
TO COME TO BETTER UNDERSTAND,

989
00:37:17,526 --> 00:37:23,432
DEBATE AND EMBRACE EBM+.

990
00:37:23,432 --> 00:37:25,300
SO HOW WOULD EBM+ WORK IN

991
00:37:25,300 --> 00:37:29,037
PRACTICE IN THIS SORT OF HEALTH

992
00:37:29,037 --> 00:37:30,339
SITUATION?

993
00:37:30,339 --> 00:37:32,040
WELL, ONE APPROACH IS TO USE

994
00:37:32,040 --> 00:37:33,408
STANDARD TECHNIQUES FOR

995
00:37:33,408 --> 00:37:38,213
ASSESSING ASSOCIATION STUDIES TO

996
00:37:38,213 --> 00:37:40,849
COME UP WITH A PRELIMINARY

997
00:37:40,849 --> 00:37:42,384
CAUSATION, AND THEN IF THAT

998
00:37:42,384 --> 00:37:43,352
PRELIMINARY EVALUATION FINDS

999
00:37:43,352 --> 00:37:45,454
THAT CAUSATION ISN'T ESTABLISHED

1000
00:37:45,454 --> 00:37:47,289
AND THAT SPECIFIC MECHANISM

1001
00:37:47,289 --> 00:37:48,423
HYPOTHESES COULD MAKE A

1002
00:37:48,423 --> 00:37:50,058
DIFFERENCE TO THE OVERALL

1003
00:37:50,058 --> 00:37:54,863
JUDGMENT OF CAUSATION, THEN

1004
00:37:54,863 --> 00:37:56,164
SCRUTINIZE MECHANISTIC STUDIES

1005
00:37:56,164 --> 00:37:58,934
TO SEE WHETHER THEY CONFIRM OR

1006
00:37:58,934 --> 00:38:05,240
UNDERMINE JUDGMENTS OF CAUSAT 

1007
00:38:05,240 --> 00:38:06,341
CAUSATION.

1008
00:38:06,341 --> 00:38:08,443
AND WE CAN DEVELOP A STEP-WISE

1009
00:38:08,443 --> 00:38:09,645
PROCEDURE FOR GOING THROUGH THIS

1010
00:38:09,645 --> 00:38:10,412
APPROACH.

1011
00:38:10,412 --> 00:38:11,947
FIRST SPECIFY THE CAUSAL CLAIM,

1012
00:38:11,947 --> 00:38:13,448
CORRELATION CLAIM, AND YOUR

1013
00:38:13,448 --> 00:38:17,419
SPECIFIC MECHANISM HYPOTHESES.

1014
00:38:17,419 --> 00:38:19,755
THEN YOU USE STANDARD TECHNIQUES

1015
00:38:19,755 --> 00:38:20,922
TO SEARCH FOR AND ASSESS

1016
00:38:20,922 --> 00:38:21,757
ASSOCIATION STUDIES.

1017
00:38:21,757 --> 00:38:23,325
YOU COME UP WITH A PRELIMINARY

1018
00:38:23,325 --> 00:38:24,293
EVALUATION, AND THIS WILL TELL

1019
00:38:24,293 --> 00:38:26,595
YOU WHETHER YOU NEED TO DO A

1020
00:38:26,595 --> 00:38:27,696
MECHANISTIC EVALUATION.

1021
00:38:27,696 --> 00:38:29,965
MOST CASES YOU WILL NEED TO

1022
00:38:29,965 --> 00:38:32,234
BECAUSE MECHANISM HYPOTHESES MAY

1023
00:38:32,234 --> 00:38:35,103
MAKE A DIFFERENCE TO THE OVERALL

1024
00:38:35,103 --> 00:38:37,072
JUDGMENTS.

1025
00:38:37,072 --> 00:38:39,508
IN THAT CASE YOU SUCH FOR

1026
00:38:39,508 --> 00:38:40,909
MECHANISTIC STUDIES, ASSESS

1027
00:38:40,909 --> 00:38:42,644
THOSE STUDIES AND THEN ASSESS

1028
00:38:42,644 --> 00:38:44,079
THE SPECIFIC MECHANISM

1029
00:38:44,079 --> 00:38:44,379
HYPOTHESES.

1030
00:38:44,379 --> 00:38:46,915
THEN YOU CAN REVISE YOUR

1031
00:38:46,915 --> 00:38:48,483
PRELIMINARY JUDGMENTS ABOUT

1032
00:38:48,483 --> 00:38:50,752
CORRELATION MECHANISM AND THE

1033
00:38:50,752 --> 00:38:54,489
CAUSAL CLAIM IN THE LIGHT OF

1034
00:38:54,489 --> 00:38:56,058
MECHANIC TIS EVIDENCE TAKEN

1035
00:38:56,058 --> 00:38:56,792
ALONGSIDE THE ASSOCIATION

1036
00:38:56,792 --> 00:38:59,061
STUDIES.

1037
00:38:59,061 --> 00:39:00,696
SO I'M GOING TO LOOK VERY

1038
00:39:00,696 --> 00:39:04,333
QUICKLY AT FACE MASK MANDATES TO

1039
00:39:04,333 --> 00:39:07,269
CONTROL COVID-19 AND HOW WE

1040
00:39:07,269 --> 00:39:10,072
MIGHT RUN THROUGH THE STEP WISE

1041
00:39:10,072 --> 00:39:11,640
PROCEDURE TO ASSESS FACE MASK

1042
00:39:11,640 --> 00:39:12,074
MANDATES.

1043
00:39:12,074 --> 00:39:13,942
THIS IS QUITE TOPICAL AT THE

1044
00:39:13,942 --> 00:39:15,243
MOMENT BECAUSE THERE'S RECENTLY

1045
00:39:15,243 --> 00:39:16,578
BEEN A VERY CONTROVERSIAL

1046
00:39:16,578 --> 00:39:18,213
COCHRANE REVIEW OF FACE MASKS.

1047
00:39:18,213 --> 00:39:21,183
THIS JUST LOOKED AT RCTs AND

1048
00:39:21,183 --> 00:39:22,250
HAD SEVERAL SIGNIFICANT

1049
00:39:22,250 --> 00:39:22,918
PROBLEMS.

1050
00:39:22,918 --> 00:39:27,289
IT DIDN'T FIND STRONG EFFECT

1051
00:39:27,289 --> 00:39:30,359
SIZE, BUT THE RCTs THAT IT

1052
00:39:30,359 --> 00:39:32,961
LOOKED AT HAD QUESTIONABLE

1053
00:39:32,961 --> 00:39:35,931
RELEVANCE, AND THE ANALYSIS IT

1054
00:39:35,931 --> 00:39:39,000
TOOK TO TRY AND ESTABLISH

1055
00:39:39,000 --> 00:39:41,203
CORRELATION WAS ALSO

1056
00:39:41,203 --> 00:39:41,536
CONTROVERSIAL.

1057
00:39:41,536 --> 00:39:45,240
SO WE'LL LOOK AND SEE HOW

1058
00:39:45,240 --> 00:39:46,541
EVIDENTIAL PLURALISM KEEPS WITH

1059
00:39:46,541 --> 00:39:48,744
THIS, AND THIS IS JOINT WORK

1060
00:39:48,744 --> 00:39:52,881
WITH MY COLLEAGUE ALEXANDRA

1061
00:39:52,881 --> 00:39:53,215
TROFIMOV.

1062
00:39:53,215 --> 00:39:54,616
WHAT ARE THE MECHANISM

1063
00:39:54,616 --> 00:39:56,284
HYPOTHESES HERE?

1064
00:39:56,284 --> 00:39:57,919
WELL, WE KNOW THAT COVID LEADS

1065
00:39:57,919 --> 00:40:00,222
TO A PREVALENCE OF COVID

1066
00:40:00,222 --> 00:40:03,125
INFECTIONS IN THE POPULATION BY

1067
00:40:03,125 --> 00:40:06,995
THREE MECHANISMS:  AEROSOL,

1068
00:40:06,995 --> 00:40:10,165
DROPLET AND FOE MIGHT, AND THIS

1069
00:40:10,165 --> 00:40:12,467
LEADS TO COVID SYMPTOMS WHICH

1070
00:40:12,467 --> 00:40:19,374
CAN RESULT IN SEVERE DISEASE,

1071
00:40:19,374 --> 00:40:20,342
HOSPITALIZATION AND DEATH.

1072
00:40:20,342 --> 00:40:22,210
MASK REGULATIONS ARE

1073
00:40:22,210 --> 00:40:23,945
HYPOTHESIZED TO LEAD TO

1074
00:40:23,945 --> 00:40:25,814
WIDESPREAD MASK USAGE BY TWO

1075
00:40:25,814 --> 00:40:26,515
PATHWAYS.

1076
00:40:26,515 --> 00:40:29,151
ONE INVOLVING ENFORCEMENT AND

1077
00:40:29,151 --> 00:40:31,553
SANCTIONS, AND THE OTHER

1078
00:40:31,553 --> 00:40:32,554
ATTRIBUTABLE TO THE EXPRESS

1079
00:40:32,554 --> 00:40:35,490
SIEVE NATURE OF THE LAW, SHOWING

1080
00:40:35,490 --> 00:40:40,095
US WHAT WE OUGHT TO DO.

1081
00:40:40,095 --> 00:40:42,697
HYPOTHESIZED MECHANISM,

1082
00:40:42,697 --> 00:40:43,799
COUNTERACTING MECHANISM IS THAT

1083
00:40:43,799 --> 00:40:45,333
MASK USE MIGHT INCREASE THE

1084
00:40:45,333 --> 00:40:47,102
PREVALENCE OF COVID SYMPTOMS BY

1085
00:40:47,102 --> 00:40:48,837
REDUCING THE UPTAKE THE OTHER

1086
00:40:48,837 --> 00:40:49,938
PUBLIC HEALTH MEASURES, SO

1087
00:40:49,938 --> 00:40:52,474
THERE'S A WORRY THAT MAYBE IF WE

1088
00:40:52,474 --> 00:40:57,279
WEAR MASKS, WE'LL BE LESS LIKELY

1089
00:40:57,279 --> 00:40:59,581
TO TAKE UP OTHER PUBLIC HEALTH

1090
00:40:59,581 --> 00:41:01,349
INTERVENTIONS AND THAT MIGHT

1091
00:41:01,349 --> 00:41:08,457
COUNTERACT THE MECHANISM.

1092
00:41:08,457 --> 00:41:10,192
SO HOW ARE WE TO EVALUATE THIS?

1093
00:41:10,192 --> 00:41:11,526
FIRST WE HAVE TO SPECIFY THE

1094
00:41:11,526 --> 00:41:12,861
CAUSAL CLAIM, AND THIS IS THE

1095
00:41:12,861 --> 00:41:14,596
LEGAL MANDATE TO WEAR FACE

1096
00:41:14,596 --> 00:41:17,132
MASKS, REDUCE THE PREVALENCE OF

1097
00:41:17,132 --> 00:41:18,133
SYMPTOMATIC INFECTIONS.

1098
00:41:18,133 --> 00:41:20,769
WE ALSO NEED TO SPECIFY THE

1099
00:41:20,769 --> 00:41:23,071
CORRELATION CLAIM, AND THIS

1100
00:41:23,071 --> 00:41:25,240
INCLUDES LISTING POTENTIAL

1101
00:41:25,240 --> 00:41:25,574
CONFOUNDERS.

1102
00:41:25,574 --> 00:41:29,244
AND THEN WE NEED TO FORMULATE

1103
00:41:29,244 --> 00:41:30,278
SPECIFIC MECHANISM HYPOTHESES.

1104
00:41:30,278 --> 00:41:32,047
SO THERE'S THE MECHANISM OF

1105
00:41:32,047 --> 00:41:34,349
ACTION, THE LEGAL REQUIREMENT

1106
00:41:34,349 --> 00:41:35,750
INCREASES FACE MASK USE WHICH

1107
00:41:35,750 --> 00:41:38,720
REDUCES THE PREVALENCE OF COVID,

1108
00:41:38,720 --> 00:41:40,922
AND THEN HYPOTHESIZE

1109
00:41:40,922 --> 00:41:42,557
COUNTERACTING MECHANISM THAT

1110
00:41:42,557 --> 00:41:44,426
WEARING FACE MASKS WILL DECREASE

1111
00:41:44,426 --> 00:41:45,627
COMPLIANCE WITH OTHER PUBLIC

1112
00:41:45,627 --> 00:41:49,564
HEALTH MEASURES.

1113
00:41:49,564 --> 00:41:51,099
WE SEARCH FOR AND ASSESS

1114
00:41:51,099 --> 00:41:52,200
ASSOCIATION STUDIES, SO I'M NOT

1115
00:41:52,200 --> 00:41:53,969
GOING TO GO THROUGH THIS IN ANY

1116
00:41:53,969 --> 00:41:55,370
DETAIL BECAUSE THIS IS KIND OF

1117
00:41:55,370 --> 00:41:58,006
THE STANDARD APPROACH.

1118
00:41:58,006 --> 00:41:59,207
LOOKING AT ASSOCIATION STUDIES.

1119
00:41:59,207 --> 00:42:01,309
YOU FIND THAT ASSOCIATION

1120
00:42:01,309 --> 00:42:05,914
STUDIES TEND TO BE RELATIVELY

1121
00:42:05,914 --> 00:42:08,550
STRONG HERE IN LOOKING AT THE

1122
00:42:08,550 --> 00:42:09,417
EFFECTIVE -- PROVIDING STRONG

1123
00:42:09,417 --> 00:42:11,152
SUPPORT FOR THE EFFECTIVENESS OF

1124
00:42:11,152 --> 00:42:18,393
FACE MASK MANDATES.

1125
00:42:18,393 --> 00:42:19,694
AND PRELIMINARY DETERMINATION IS

1126
00:42:19,694 --> 00:42:21,663
THAT THE EVIDENCE FROM THESE

1127
00:42:21,663 --> 00:42:24,199
STUDIES ESTABLISHES THE

1128
00:42:24,199 --> 00:42:25,300
CORRELATION CLAIM BUT IT FALLS

1129
00:42:25,300 --> 00:42:29,237
SHORT OF ESTABLISH THE CAUSAL

1130
00:42:29,237 --> 00:42:30,672
CLAIM BECAUSE THERE MAY BE SOME

1131
00:42:30,672 --> 00:42:33,642
RESIDUAL CONFOUNDING THAT HASN'T

1132
00:42:33,642 --> 00:42:35,076
BEEN ADEQUATELY CONTROLLED FOR

1133
00:42:35,076 --> 00:42:36,378
BY THESE STUDIES.

1134
00:42:36,378 --> 00:42:39,648
SO THE CAUSAL CLAIM IS ONLY

1135
00:42:39,648 --> 00:42:40,649
PROVISIONALLY ESTABLISHED, AND

1136
00:42:40,649 --> 00:42:42,918
THE MECHANISTIC EVALUATION COULD

1137
00:42:42,918 --> 00:42:43,919
INCREASE CONFIDENCE IN THE

1138
00:42:43,919 --> 00:42:44,352
CAUSAL CLAIM.

1139
00:42:44,352 --> 00:42:46,221
SO WE DO NEED TO GO ON TO CARRY

1140
00:42:46,221 --> 00:42:49,190
OUT A MECHANISTIC EVALUATION

1141
00:42:49,190 --> 00:42:50,825
HERE.

1142
00:42:50,825 --> 00:42:52,694
SO WE SEARCH FOR AND ASSESS

1143
00:42:52,694 --> 00:42:54,129
MECHANISTIC STUDIES.

1144
00:42:54,129 --> 00:42:55,430
THERE'S TWO PARTS TO THE

1145
00:42:55,430 --> 00:42:56,531
MECHANISM OF ACTION.

1146
00:42:56,531 --> 00:42:59,267
THE FIRST PART IS DOES THE

1147
00:42:59,267 --> 00:43:02,003
MANDATE -- THE FACE MASK MANDATE

1148
00:43:02,003 --> 00:43:04,306
ACTUALLY LEAD TO COMPLIANCE, DO

1149
00:43:04,306 --> 00:43:06,942
WE USE FACE MASKS, AND HERE

1150
00:43:06,942 --> 00:43:08,910
THERE IS VERY GOOD SUPPORT FROM

1151
00:43:08,910 --> 00:43:11,980
STUDIES THAT THIS PART OF THE

1152
00:43:11,980 --> 00:43:14,749
MECHANISM EXISTS, BUT AGAIN,

1153
00:43:14,749 --> 00:43:19,454
IT'S NOT ENTIRELY CONCLUSIVE.

1154
00:43:19,454 --> 00:43:20,855
THE SECOND PART OF THE MECHANISM

1155
00:43:20,855 --> 00:43:22,190
HYPOTHESIS CONCERNS THE

1156
00:43:22,190 --> 00:43:24,159
EFFECTIVENESS OF FACE MASKS IN

1157
00:43:24,159 --> 00:43:25,727
REDUCING SYMPTOMATIC INFECTION,

1158
00:43:25,727 --> 00:43:27,896
SO GIVEN THAT WE USE FACE MASKS,

1159
00:43:27,896 --> 00:43:30,632
ARE THEY THEN EFFECTIVE AT

1160
00:43:30,632 --> 00:43:34,035
REDUCING SPREAD OF COVID-19.

1161
00:43:34,035 --> 00:43:37,305
AND SO WE SEARCH FOR AND ASSESS

1162
00:43:37,305 --> 00:43:41,910
STUDIES THERE TOO.

1163
00:43:41,910 --> 00:43:45,413
THE RECENT COCHRANE REVIEW

1164
00:43:45,413 --> 00:43:46,681
NEITHER SUPPORT NOR UNDERMINES

1165
00:43:46,681 --> 00:43:47,949
THE MECHANISM HYPOTHESIS BECAUSE

1166
00:43:47,949 --> 00:43:49,751
OF VARIOUS PROBLEMS WITH THE WAY

1167
00:43:49,751 --> 00:43:55,490
THE STUDY WAS CARRIED OUT.

1168
00:43:55,490 --> 00:43:56,691
WE THINK THAT THE FIRST PART OF

1169
00:43:56,691 --> 00:43:59,327
THE MECHANISM IS PROVISIONALLY

1170
00:43:59,327 --> 00:44:01,396
ESTABLISHED THAT MANDATES LEAD

1171
00:44:01,396 --> 00:44:05,233
TO WIDESPREAD USE OF FACE MASKS.

1172
00:44:05,233 --> 00:44:07,102
WHILE THE SECOND PART IS WELL

1173
00:44:07,102 --> 00:44:07,569
ESTABLISHED.

1174
00:44:07,569 --> 00:44:09,170
THERE'S VERY STRONG STUDIES WITH

1175
00:44:09,170 --> 00:44:12,907
RESPECT TO THE SECOND PART.

1176
00:44:12,907 --> 00:44:14,476
SO OVERALL, THE MECHANISM OF

1177
00:44:14,476 --> 00:44:15,677
ACTION IS PROVISIONALLY

1178
00:44:15,677 --> 00:44:16,011
ESTABLISHED.

1179
00:44:16,011 --> 00:44:17,312
THIS IS BECAUSE THE FIRST PART

1180
00:44:17,312 --> 00:44:19,180
IS ONLY PROVISIONALLY

1181
00:44:19,180 --> 00:44:21,049
ESTABLISHED.

1182
00:44:21,049 --> 00:44:23,652
THE COUNTERACTING MECHANISM HAS

1183
00:44:23,652 --> 00:44:25,854
BEEN COMPREHENSIVELY UNDERMINED

1184
00:44:25,854 --> 00:44:31,126
BY STUDIES IN THE LITERATURE.

1185
00:44:31,126 --> 00:44:32,093
AND THE VIEW IS THAT THE

1186
00:44:32,093 --> 00:44:33,328
CONTRACTING MECHANISM IS

1187
00:44:33,328 --> 00:44:36,698
ARGUABLY FALSE.

1188
00:44:36,698 --> 00:44:39,000
SO THEN WE NEED TO REVISE OUR

1189
00:44:39,000 --> 00:44:40,535
INITIAL JUDGMENT OF CORRELATION,

1190
00:44:40,535 --> 00:44:43,705
WHICH REMAINS ESTABLISHED, BUT

1191
00:44:43,705 --> 00:44:45,473
GIVEN CONCORDANT STRONG EVIDENCE

1192
00:44:45,473 --> 00:44:47,308
FROM ASSOCIATION STUDIES AND

1193
00:44:47,308 --> 00:44:48,209
MECHANISTIC STUDIES, WE

1194
00:44:48,209 --> 00:44:49,878
DETERMINE THAT THE GENERAL

1195
00:44:49,878 --> 00:44:50,512
MECHANISTIC CLAIM IS

1196
00:44:50,512 --> 00:44:57,619
ESTABLISHED.

1197
00:44:57,619 --> 00:44:58,820
AND SINCE BOTH CORRELATION AND

1198
00:44:58,820 --> 00:44:59,921
MECHANISM ARE ESTABLISHED, THE

1199
00:44:59,921 --> 00:45:00,722
CAUSAL CLAIM IS ALSO

1200
00:45:00,722 --> 00:45:01,122
ESTABLISHED.

1201
00:45:01,122 --> 00:45:03,658
SO THE PICTURE LOOKS LIKE THIS.

1202
00:45:03,658 --> 00:45:05,093
IT'S A BIT MORE COMPLICATED THAN

1203
00:45:05,093 --> 00:45:06,728
THE ONES WE'VE SEEN EARLIER.

1204
00:45:06,728 --> 00:45:08,797
THE ASSOCIATION STUDIES SUFFICE

1205
00:45:08,797 --> 00:45:10,899
ON THEIR OWN TO ESTABLISH

1206
00:45:10,899 --> 00:45:11,433
CORRELATION.

1207
00:45:11,433 --> 00:45:13,334
THEY PROVIDE SOME FAIRLY STRONG

1208
00:45:13,334 --> 00:45:14,969
SUPPORT FOR THE PRESENCE OF A

1209
00:45:14,969 --> 00:45:16,271
LINKING MECHANISM, BUT THEY

1210
00:45:16,271 --> 00:45:17,238
DON'T SUFFICE TO ESTABLISH A

1211
00:45:17,238 --> 00:45:18,573
MECHANISM.

1212
00:45:18,573 --> 00:45:21,509
 THERE.

1213
00:45:21,509 --> 00:45:22,510
MECHANISTIC STUDIES PROVIDE

1214
00:45:22,510 --> 00:45:26,781
STRONG SUPPORT FOR MECHANISM

1215
00:45:26,781 --> 00:45:31,286
HYPOTHESES, WHICH END UP HAVING

1216
00:45:31,286 --> 00:45:32,153
BEEN PROVISIONALLY ESTABLISHED

1217
00:45:32,153 --> 00:45:33,488
AND ALSO PROVIDE STRONG SUPPORT

1218
00:45:33,488 --> 00:45:34,556
FOR THE LINKING MECHANISM.

1219
00:45:34,556 --> 00:45:36,458
BUT AGAIN, MECHANISTIC STUDIES

1220
00:45:36,458 --> 00:45:37,926
ON THEIR OWN DON'T SUFFICE TO

1221
00:45:37,926 --> 00:45:40,261
ESTABLISH THE MECHANISM CLAIM.

1222
00:45:40,261 --> 00:45:41,696
BUT TAKING THE STRONG SUPPORT

1223
00:45:41,696 --> 00:45:43,231
FROM THE ASSOCIATION STUDIES AND

1224
00:45:43,231 --> 00:45:46,735
THE MECHANISTIC STUDIES TOGET 

1225
00:45:46,735 --> 00:45:49,370
TOGETHER, THE MECHANISM CLAIM

1226
00:45:49,370 --> 00:45:52,307
CAN ONLY BE VIEWED AS WELL

1227
00:45:52,307 --> 00:45:53,408
ESTABLISHED.

1228
00:45:53,408 --> 00:45:54,409
AND ONCE CORRELATION AND

1229
00:45:54,409 --> 00:45:55,610
MECHANISM ARE ESTABLISHED, SO,

1230
00:45:55,610 --> 00:46:00,882
TOO, IS CAUSATION ESTABLISHED.

1231
00:46:00,882 --> 00:46:03,718
SO JUST TO SUM UP THEN,

1232
00:46:03,718 --> 00:46:05,353
EVIDENTIAL PLURALISM PROVIDES AN

1233
00:46:05,353 --> 00:46:08,089
OVERARCHING FRAMEWORK FOR CAUSAL

1234
00:46:08,089 --> 00:46:08,656
INFERENCE.

1235
00:46:08,656 --> 00:46:11,426
THIS BRIDGES CLINICAL STUDIES,

1236
00:46:11,426 --> 00:46:12,494
EPIDEMIOLOGICAL STUDIES ON THE

1237
00:46:12,494 --> 00:46:13,895
ONE HAND WITH BASIC SCIENCE ON

1238
00:46:13,895 --> 00:46:15,997
THE OTHER AND THAT BASIC SCIENCE

1239
00:46:15,997 --> 00:46:18,967
IS THE PANDEMIC CLEARLY

1240
00:46:18,967 --> 00:46:19,701
SHOWS/INCLUDES BEHAVIORAL AND

1241
00:46:19,701 --> 00:46:22,837
SOCIAL SCIENCE.

1242
00:46:22,837 --> 00:46:23,905
EVIDENTIAL PLURALISM CAN BE

1243
00:46:23,905 --> 00:46:25,473
APPLIED TO BOTH MEDICINE AND

1244
00:46:25,473 --> 00:46:27,876
POLICY ASSESSMENT, AND CAN HELP

1245
00:46:27,876 --> 00:46:34,115
TO RESOLVE CONTROVERSIES SUCH AS

1246
00:46:34,115 --> 00:46:35,984
THE EFFECTIVENESS OF FACE MASK

1247
00:46:35,984 --> 00:46:36,451
MANDATES.

1248
00:46:36,451 --> 00:46:44,859
THANK YOU VERY MUCH.

1249
00:46:44,859 --> 00:46:49,798
>> THANK YOU SO MUCH, JON.

1250
00:46:49,798 --> 00:46:51,332
LET'S LEAVE THAT QR CODE UP FOR

1251
00:46:51,332 --> 00:46:52,834
A FEW MOMENTS SO OUR COLLEAGUES

1252
00:46:52,834 --> 00:46:59,440
CAN TAKE A PHOTO OR USE THEIR

1253
00:46:59,440 --> 00:47:00,241
CRAFTER FOR THAT.

1254
00:47:00,241 --> 00:47:01,109
I'LL START WITH THE QUESTIONS

1255
00:47:01,109 --> 00:47:05,713
THAT HAVE COME IN, AND MY

1256
00:47:05,713 --> 00:47:14,289
COLLEAGUE ON THIS TEAM --

1257
00:47:14,289 --> 00:47:15,356
[AUDIO DIFFICULTIES]

1258
00:47:15,356 --> 00:47:18,560
>> SORRY, BILL, I'VE LOST
YOU.

1259
00:47:18,560 --> 00:47:23,131
>>  -- WILL ALTERNATE.

1260
00:47:23,131 --> 00:47:25,466
I BEG YOUR PARD3?

1261
00:47:25,466 --> 00:47:31,606
PARDON?>> YOU CUT OUT.

1262
00:47:31,606 --> 00:47:33,141
>> I'M SORRY, IS THIS ANY

1263
00:47:33,141 --> 00:47:33,374
BETTER?

1264
00:47:33,374 --> 00:47:35,476
>> YES, THAT'S BETTER NOW.

1265
00:47:35,476 --> 00:47:36,578
>> OH, GOOD.

1266
00:47:36,578 --> 00:47:46,421
OUR BASIC SCIENTISTS HAVE --

1267
00:47:46,421 --> 00:47:55,830
[AUDIO DIFFICULTIES ?C]

1268
00:47:55,830 --> 00:47:58,032
STATED THEY'VE BEEN USING THE

1269
00:47:58,032 --> 00:48:01,302
EVIDENTIAL PLURALISM FOR YEARS,

1270
00:48:01,302 --> 00:48:04,239
BUT -- DO YOU RECOMMEND A GOOD

1271
00:48:04,239 --> 00:48:07,342
PLACE FOR THEM TO START?

1272
00:48:07,342 --> 00:48:11,312
TO LEARN MORE ABOUT HOW

1273
00:48:11,312 --> 00:48:12,714
EVIDENTIAL PLURALISM GOT ITS

1274
00:48:12,714 --> 00:48:15,250
START AND HOW THEY MIGHT BEGIN

1275
00:48:15,250 --> 00:48:17,118
TO INTEGRATE IT INTO THEIR OWN

1276
00:48:17,118 --> 00:48:18,953
WORK WHICH THEY SEE RELATES SO

1277
00:48:18,953 --> 00:48:21,489
CLOSELY TO YOURS?

1278
00:48:21,489 --> 00:48:23,157
>> I THINK THAT'S A VERY
GOOD

1279
00:48:23,157 --> 00:48:25,126
QUESTION.

1280
00:48:25,126 --> 00:48:29,264
SO MY SUGGESTION IS TO HAVE A

1281
00:48:29,264 --> 00:48:33,101
LOOK AT LITERATURE ON EVIDENTIAL

1282
00:48:33,101 --> 00:48:34,969
PLURALISM THAT I LEFT UP THE

1283
00:48:34,969 --> 00:48:35,970
LINK TO AT THE END.

1284
00:48:35,970 --> 00:48:38,306
THAT INCLUDES THE TWO BOOKS,

1285
00:48:38,306 --> 00:48:39,574
EVIDENTIAL PLURALISM IN

1286
00:48:39,574 --> 00:48:41,976
MEDICINE, AND IN THE SOCIAL

1287
00:48:41,976 --> 00:48:43,411
SCIENCES.

1288
00:48:43,411 --> 00:48:47,048
IT'S CERTAINLY TRUE, ALTHOUGH --

1289
00:48:47,048 --> 00:48:50,785
SO THE STANDARD APPROACH IN

1290
00:48:50,785 --> 00:48:53,955
EVALUATION IS EVIDENCE-BASED

1291
00:48:53,955 --> 00:48:55,690
MEDICINE AND EVIDENCE-BASED

1292
00:48:55,690 --> 00:49:00,628
POLICY, AND THIS CONTRASTS QUITE

1293
00:49:00,628 --> 00:49:01,296
STRONGLY WITH EVIDENTIAL

1294
00:49:01,296 --> 00:49:02,063
PLURALISM.

1295
00:49:02,063 --> 00:49:05,133
BUT BASIC SCIENTISTS DO

1296
00:49:05,133 --> 00:49:06,434
NATURALLY THINK OFTEN IN TERMS

1297
00:49:06,434 --> 00:49:11,806
OF MECHANISMS ALONGSIDE

1298
00:49:11,806 --> 00:49:12,674
ASSOCIATIONS WHEN TRYING TO

1299
00:49:12,674 --> 00:49:16,144
ESTABLISH CAUSATION, AND

1300
00:49:16,144 --> 00:49:17,912
EVIDENTIAL PLURALISM CAN BE

1301
00:49:17,912 --> 00:49:20,048
VIEWED AS SOME KIND OF GENERAL

1302
00:49:20,048 --> 00:49:22,216
PHILOSOPHICAL UNDERPINNING FOR

1303
00:49:22,216 --> 00:49:24,419
THIS NATURAL WAY OF SEEING

1304
00:49:24,419 --> 00:49:24,752
THINGS.

1305
00:49:24,752 --> 00:49:28,723
SO IT CAN BE VIEWED AS PROVIDING

1306
00:49:28,723 --> 00:49:29,524
PHILOSOPHICAL FOUNDATIONS FOR

1307
00:49:29,524 --> 00:49:31,225
THIS APPROACH TO ASSESSING

1308
00:49:31,225 --> 00:49:32,760
CAUSATION.

1309
00:49:32,760 --> 00:49:34,963
AND A GENERAL OVERARCHING

1310
00:49:34,963 --> 00:49:39,334
FRAMEWORK WITHIN WHICH MANY WELL

1311
00:49:39,334 --> 00:49:41,970
DEVELOPED METHODS CAN FIT INTO.

1312
00:49:41,970 --> 00:49:43,404
SO FOR EXAMPLE, I MENTIONED

1313
00:49:43,404 --> 00:49:44,706
MIXED METHOD RESEARCH, WHICH HAS

1314
00:49:44,706 --> 00:49:48,109
BEEN STRONG FOR A LONG TIME.

1315
00:49:48,109 --> 00:49:48,876
EVIDENTIAL PLURALISM CAN BE

1316
00:49:48,876 --> 00:49:51,212
THOUGHT OF AS PROVIDING SOME

1317
00:49:51,212 --> 00:49:53,581
JUSTIFICATION FOR MIXED METHODS

1318
00:49:53,581 --> 00:49:56,351
RESEARCH THAT DIFFERS FROM OTHER

1319
00:49:56,351 --> 00:49:57,352
JUSTIFICATIONS THAT ARE AROUND

1320
00:49:57,352 --> 00:50:02,590
IN THE SOCIAL SCIENCES.

1321
00:50:02,590 --> 00:50:03,891
>> THANKS SO MUCH.

1322
00:50:03,891 --> 00:50:04,559
BECKY?

1323
00:50:04,559 --> 00:50:05,326
>> YES, THANK YOU.

1324
00:50:05,326 --> 00:50:07,762
I HAVE ANOTHER QUESTION FROM THE

1325
00:50:07,762 --> 00:50:08,730
AUDIENCE.

1326
00:50:08,730 --> 00:50:10,698
HOW DOES EBM HANDLE PUBLICATION

1327
00:50:10,698 --> 00:50:13,768
BIAS?

1328
00:50:13,768 --> 00:50:17,572
>> SO PUBLICATION BIAS IS
USED

1329
00:50:17,572 --> 00:50:21,342
AS A WAY TO ASSESS QUALITY OF

1330
00:50:21,342 --> 00:50:23,845
ASSOCIATION STUDIES, STANDARDLY

1331
00:50:23,845 --> 00:50:26,247
BY EVIDENCE-BASED MEDICINE,

1332
00:50:26,247 --> 00:50:29,617
EVIDENCE-BASED POLICY, AND

1333
00:50:29,617 --> 00:50:30,218
EVIDENTIAL PLURALISM WOULD USE

1334
00:50:30,218 --> 00:50:30,985
THAT IN THE SAME WAY.

1335
00:50:30,985 --> 00:50:33,187
SO SOMETIMES WE CAN ASSESS THE

1336
00:50:33,187 --> 00:50:34,922
LIKELIHOOD OF PUBLICATION BIAS

1337
00:50:34,922 --> 00:50:39,761
IN A PARTICULAR AREA, AND DO

1338
00:50:39,761 --> 00:50:41,963
RISK OF BIAS ASSESSMENTS FOR

1339
00:50:41,963 --> 00:50:43,231
THESE ASSOCIATION STUDIES, AND

1340
00:50:43,231 --> 00:50:47,435
THE PRESENCE OF PUBLICATION BIAS

1341
00:50:47,435 --> 00:50:50,171
OFTEN LEADS US TO VIEW THE

1342
00:50:50,171 --> 00:50:52,140
ASSOCIATION STUDIES AS

1343
00:50:52,140 --> 00:50:53,174
INSUFFICIENT TO ESTABLISH

1344
00:50:53,174 --> 00:50:56,344
CAUSATION ON THEIR OWN.

1345
00:50:56,344 --> 00:50:57,879
SO THE PRESENCE OF PUBLICATION

1346
00:50:57,879 --> 00:51:00,815
BIAS LEADS TO THE FEED TO LOOK

1347
00:51:00,815 --> 00:51:03,251
AT MECHANISTIC EVIDENCE

1348
00:51:03,251 --> 00:51:04,585
ALONGSIDE ASSOCIATION STUDIES TO

1349
00:51:04,585 --> 00:51:08,089
SEE WHETHER WE CAN HELP TO

1350
00:51:08,089 --> 00:51:11,592
ESTABLISH CAUSATION.

1351
00:51:11,592 --> 00:51:13,261
PUBLICATION BIAS IS PERHAPS LESS

1352
00:51:13,261 --> 00:51:15,096
PROMINENT IN THE MECHANISTIC

1353
00:51:15,096 --> 00:51:16,431
LITERATURE THAN IN THE

1354
00:51:16,431 --> 00:51:20,034
LITERATURE, FOR EXAMPLE, ON

1355
00:51:20,034 --> 00:51:20,935
RANDOMIZED CONTROL TRIALS.

1356
00:51:20,935 --> 00:51:23,337
SO LOOKING AT MECHANISTIC

1357
00:51:23,337 --> 00:51:25,807
STUDIES CAN HELP PROVIDE AN

1358
00:51:25,807 --> 00:51:29,343
INDEPENDENT SOURCE OF EVIDENCE

1359
00:51:29,343 --> 00:51:32,447
THAT CAN BE USED TO BOOST OR

1360
00:51:32,447 --> 00:51:33,448
UNDERMINE JUDGMENTS OF

1361
00:51:33,448 --> 00:51:42,957
CAUSATION.

1362
00:51:42,957 --> 00:51:45,026
>> OUR NIH ASSOCIATE
DIRECTOR

1363
00:51:45,026 --> 00:51:47,462
FOR BEHAVIORAL AND SOCIAL

1364
00:51:47,462 --> 00:51:49,697
SCIENCES HAD SOME TECHNICAL

1365
00:51:49,697 --> 00:51:52,266
DIFFICULTIES GETTING ON AT THE

1366
00:51:52,266 --> 00:51:56,437
BEGINNING, AS YOU KNOW, JON, AND

1367
00:51:56,437 --> 00:51:59,073
SO SHE'D LIKE TO COME ON AND ASK

1368
00:51:59,073 --> 00:52:05,213
HER OWN QUESTION ADG AND PROVIDU

1369
00:52:05,213 --> 00:52:06,013
HER SINCERE THANKS.

1370
00:52:06,013 --> 00:52:06,714
JANE?

1371
00:52:06,714 --> 00:52:07,582
>> OKAY.

1372
00:52:07,582 --> 00:52:08,883
I DIDN'T KNOW YOU WERE GOING TO

1373
00:52:08,883 --> 00:52:09,984
HAVE ME GO ON AT THE END.

1374
00:52:09,984 --> 00:52:11,219
I DON'T KNOW IF I'M IN A PLACE

1375
00:52:11,219 --> 00:52:13,087
WHERE YOU CAN HEAR ME VERY WELL

1376
00:52:13,087 --> 00:52:13,821
ACTUALLY.

1377
00:52:13,821 --> 00:52:15,256
BUT I'M SORRY WE COULDN'T GET

1378
00:52:15,256 --> 00:52:15,456
ON --

1379
00:52:15,456 --> 00:52:19,894
>> YOU SOUND GREAT.

1380
00:52:19,894 --> 00:52:21,295
>> OKAY.

1381
00:52:21,295 --> 00:52:21,963
FASCINATING TALK.

1382
00:52:21,963 --> 00:52:23,731
I'M LOOKING FORWARD TO LOOKING

1383
00:52:23,731 --> 00:52:24,966
AT THIS A LITTLE BIT IN MORE

1384
00:52:24,966 --> 00:52:25,199
DETAIL.

1385
00:52:25,199 --> 00:52:27,235
I DIDN'T HAVE A SPECIFIC

1386
00:52:27,235 --> 00:52:28,536
QUESTION BUT JUST WANTED TO

1387
00:52:28,536 --> 00:52:30,204
APOLOGIZE FOR NOT BEING ON AT

1388
00:52:30,204 --> 00:52:30,872
THE BEGINNING.

1389
00:52:30,872 --> 00:52:32,106
I'M SURE, BILL, YOU WERE ABLE TO

1390
00:52:32,106 --> 00:52:33,708
DO THE INTRODUCTION THEN?

1391
00:52:33,708 --> 00:52:34,475
>> THANK YOU VERY MUCH.

1392
00:52:34,475 --> 00:52:35,376
>> YES.

1393
00:52:35,376 --> 00:52:36,043
>> GREAT.

1394
00:52:36,043 --> 00:52:39,981
OKAY.

1395
00:52:39,981 --> 00:52:41,415
THANK YOU.

1396
00:52:41,415 --> 00:52:45,786
>> THANK YOU.

1397
00:52:45,786 --> 00:52:47,755
>> OH, YOU BET.

1398
00:52:47,755 --> 00:52:51,926
WE HAVE ONE MORE -- ANOTHER

1399
00:52:51,926 --> 00:52:56,297
QUESTION ABOUT FINDING PERHAPS

1400
00:52:56,297 --> 00:52:58,266
ATTEMPTS TO FIND CAUSALITY USING

1401
00:52:58,266 --> 00:53:01,736
YOUR APPROACHES IN A GREAT MANY

1402
00:53:01,736 --> 00:53:03,905
OF BEHAVIORAL INTERVENTIONS THAT

1403
00:53:03,905 --> 00:53:08,075
HAVE GONE ON OVER THE PAST 40,

1404
00:53:08,075 --> 00:53:08,943
50 YEARS.

1405
00:53:08,943 --> 00:53:11,846
IN PARTICULAR, THOSE THAT

1406
00:53:11,846 --> 00:53:14,448
HYPOTHESIZE THAT A CHANGE IN

1407
00:53:14,448 --> 00:53:18,186
SELF-EFFICACY CAN PREDICT

1408
00:53:18,186 --> 00:53:20,688
HEALTHIER BEHAVIOR, EITHER TO

1409
00:53:20,688 --> 00:53:23,324
CHANGE OR ADHERENCE IN THAT

1410
00:53:23,324 --> 00:53:24,192
REGARD.

1411
00:53:24,192 --> 00:53:26,961
THERE ARE MANY PUBLICATIONS,

1412
00:53:26,961 --> 00:53:31,299
HOWEVER, IN WHICH THAT ALL

1413
00:53:31,299 --> 00:53:32,300
HASN'T BEEN FOUND.

1414
00:53:32,300 --> 00:53:35,169
SOMETIMES SELF-EFFICACY

1415
00:53:35,169 --> 00:53:37,805
INCREASES, BUT NOT BEHAVIOR OR

1416
00:53:37,805 --> 00:53:43,177
THE REVERSE, AND GIVEN THE MANY

1417
00:53:43,177 --> 00:53:46,380
DIFFERENT WAYS YOU DEMONSTRATED

1418
00:53:46,380 --> 00:53:51,919
SO EARLY ON IN YOUR TALK, COULD

1419
00:53:51,919 --> 00:53:54,889
THE APPROACHES IN EVIDENTIAL

1420
00:53:54,889 --> 00:53:57,325
PLURALISM HELP TEASE OUT WHETHER

1421
00:53:57,325 --> 00:53:58,893
AND HOW THESE MECHANISMS WORK IN

1422
00:53:58,893 --> 00:54:04,031
OTHER WAYS OR WHAT OTHER ME CAN

1423
00:54:04,031 --> 00:54:05,233
MECHANISMS RESEARCHERS MIGHT

1424
00:54:05,233 --> 00:54:06,334
SEEK, STARTING WITH THE DATA

1425
00:54:06,334 --> 00:54:10,638
THAT THEY HAVE?

1426
00:54:10,638 --> 00:54:13,975
>> SO THAT'S AN
INTERESTING

1427
00:54:13,975 --> 00:54:14,542
QUESTION.

1428
00:54:14,542 --> 00:54:16,110
I DON'T KNOW VERY MUCH ABOUT

1429
00:54:16,110 --> 00:54:18,079
THAT PARTICULAR AREA OF

1430
00:54:18,079 --> 00:54:19,380
BEHAVIORAL SCIENCE, SO I CAN'T

1431
00:54:19,380 --> 00:54:21,582
SAY TOO MUCH ABOUT IT, BUT I

1432
00:54:21,582 --> 00:54:24,919
WOULD SAY THAT OFTEN YOU DON'T

1433
00:54:24,919 --> 00:54:29,090
NEED TO KNOW VERY MUCH ABOUT

1434
00:54:29,090 --> 00:54:32,126
MECHANISMS TO PROVIDE BOOSTING

1435
00:54:32,126 --> 00:54:33,461
EVIDENCE FOR CAUSALITY.

1436
00:54:33,461 --> 00:54:36,430
SO YOU JUST NEED TO KNOW A FEW

1437
00:54:36,430 --> 00:54:38,633
INTERMEDIARY VARIABLES, FOR

1438
00:54:38,633 --> 00:54:40,801
EXAMPLE,, A FEW MEDIATING

1439
00:54:40,801 --> 00:54:46,641
VARIABLES, AND CONFIRMING THAT

1440
00:54:46,641 --> 00:54:49,043
THE SELF-EFFICACY CAN INFLUENCE

1441
00:54:49,043 --> 00:54:50,444
THESE INTERMEDIARY VARIABLES CAN

1442
00:54:50,444 --> 00:54:54,215
IN ITSELF PROVIDE STRONG SUPPORT

1443
00:54:54,215 --> 00:54:55,316
OF CAUSATION.

1444
00:54:55,316 --> 00:55:01,622
SO I JUST SAY THAT ALL IT TAKES

1445
00:55:01,622 --> 00:55:05,359
IS A FEW KEY MECHANISTIC

1446
00:55:05,359 --> 00:55:09,330
HYPOTHESES FOR, ONE, TO BE ABLE

1447
00:55:09,330 --> 00:55:12,166
TO USE EVIDENTIAL PLURALISM TO

1448
00:55:12,166 --> 00:55:15,469
HELP BOOST -- HELP CONFIRM OR

1449
00:55:15,469 --> 00:55:16,237
UNDERMINE CAUSATION.

1450
00:55:16,237 --> 00:55:17,805
SO PERHAPS IT MIGHT BE AN

1451
00:55:17,805 --> 00:55:22,510
APPROACH TO TRY TO SEE WHETHER

1452
00:55:22,510 --> 00:55:28,082
IT CAN HELP RESOLVE THIS

1453
00:55:28,082 --> 00:55:29,050
SITUATION IN THE LITERATURE

1454
00:55:29,050 --> 00:55:29,984
WHERE PEOPLE AREN'T SURE FROM

1455
00:55:29,984 --> 00:55:34,355
THE ASSOCIATION STUDIES ON THEIR

1456
00:55:34,355 --> 00:55:36,424
OWN WHETHER THERE IS CAUSATION

1457
00:55:36,424 --> 00:55:37,858
AND THE EXTENT TO WHICH THERE IS

1458
00:55:37,858 --> 00:55:38,125
CAUSATION.

1459
00:55:38,125 --> 00:55:40,861
THANK YOU.

1460
00:55:40,861 --> 00:55:45,132
>> LOVELY.

1461
00:55:45,132 --> 00:55:48,302
WHEN YOU WERE TALKING ABOUT THE

1462
00:55:48,302 --> 00:55:49,970
POWER OF PRAYER TO HELP PEOPLE

1463
00:55:49,970 --> 00:55:52,573
SHORTLY OUT OF HOSPITAL, IT

1464
00:55:52,573 --> 00:55:54,875
TRIGGERED A QUESTION FROM ONE OF

1465
00:55:54,875 --> 00:55:56,410
OUR COLLEAGUES WHO SAID THAT

1466
00:55:56,410 --> 00:56:00,614
THAT REMINDED HER OF THE MANY

1467
00:56:00,614 --> 00:56:02,450
DISCIPLINES THAT COMPRISE THE

1468
00:56:02,450 --> 00:56:05,086
HEALTH HUMANITIES.

1469
00:56:05,086 --> 00:56:08,589
MANY OF THE LEADERS OF THAT AREA

1470
00:56:08,589 --> 00:56:09,957
ARE IN THE U.K., THOUGH NOT ALL

1471
00:56:09,957 --> 00:56:18,699
OF THEM, AND MY COLLEAGUE

1472
00:56:18,699 --> 00:56:22,103
WONDERED IF HEALTH HUMANITIES --

1473
00:56:22,103 --> 00:56:26,841
IF YOUR APPROACHES ON CAUSALITY

1474
00:56:26,841 --> 00:56:29,243
MIGHT HELP THE HEALTH HUMANITIES

1475
00:56:29,243 --> 00:56:31,779
DEMONSTRATE CAUSALITY MORE

1476
00:56:31,779 --> 00:56:38,886
DIRECTLY FOR BASIC AND MEDICAL

1477
00:56:38,886 --> 00:56:39,887
PEOPLE, IF YOU'VE WORKED WITH

1478
00:56:39,887 --> 00:56:40,988
THOSE COLLEAGUES AT ALL AND

1479
00:56:40,988 --> 00:56:42,089
COULD SPEAK TO THIS.

1480
00:56:42,089 --> 00:56:45,292
I KNOW, AGAIN, THIS IS AN ASIDE

1481
00:56:45,292 --> 00:56:47,261
QUESTION.

1482
00:56:47,261 --> 00:56:48,362
>> YEAH, THANK YOU.

1483
00:56:48,362 --> 00:56:51,298
THAT'S AN INTERESTING QUESTION.

1484
00:56:51,298 --> 00:56:55,903
CERTAINLY CERTAIN APPROACHES IN

1485
00:56:55,903 --> 00:56:57,271
THE HEALTH HUMANITIES CAN FIT

1486
00:56:57,271 --> 00:57:00,941
INTO THIS FRAMEWORK QUITE WELL.

1487
00:57:00,941 --> 00:57:03,811
SO HEALTH HUMANITY TENDS TO

1488
00:57:03,811 --> 00:57:05,179
ADVOCATE FOCUSING STRONGLY ON

1489
00:57:05,179 --> 00:57:06,714
THE PATIENT'S PERSPECTIVE,

1490
00:57:06,714 --> 00:57:10,651
PATIENT NARRATIVES, AND SO ON,

1491
00:57:10,651 --> 00:57:14,021
AND THESE CAN REALLY BE VIEWED

1492
00:57:14,021 --> 00:57:18,325
AS PROVIDING GOOD INDICATORS OF

1493
00:57:18,325 --> 00:57:19,860
FEATURES OF MECHANISMS OF

1494
00:57:19,860 --> 00:57:21,495
DISEASE BUT ALSO MECHANISMS OF

1495
00:57:21,495 --> 00:57:24,265
TREATMENT THAT WORK AS WELL.

1496
00:57:24,265 --> 00:57:26,133
SO EVIDENTIAL PLURALISM TENDS TO

1497
00:57:26,133 --> 00:57:33,340
BE PRETTY OPEN TO THIS IDEA OF

1498
00:57:33,340 --> 00:57:34,675
USING ALL THE EVIDENCE THAT

1499
00:57:34,675 --> 00:57:38,112
YOU'VE GOT AVAILABLE TO HELP

1500
00:57:38,112 --> 00:57:39,413
INFORM YOUR JUDGMENTS OF

1501
00:57:39,413 --> 00:57:41,682
CAUSATION, AND THIS CAN INCLUDE

1502
00:57:41,682 --> 00:57:45,486
THE KINDS OF TREATMENTS OF

1503
00:57:45,486 --> 00:57:47,221
ILLNESS, DISEASE AND HEALTH

1504
00:57:47,221 --> 00:57:49,423
THAT'S AVAILABLE IN THE HEALTH

1505
00:57:49,423 --> 00:57:51,926
HUMANITIES, AS WELL AS THE

1506
00:57:51,926 --> 00:57:54,228
STANDARD LARGE STATISTICAL

1507
00:57:54,228 --> 00:57:56,997
TRIALS THAT PEOPLE ARE FAMILIAR

1508
00:57:56,997 --> 00:57:59,300
WITH IN THE MEDICAL ARENA.

1509
00:57:59,300 --> 00:58:00,734
SO IT WOULD DEFINITELY BE AN

1510
00:58:00,734 --> 00:58:02,403
INTERESTING AVENUE TO EXPLORE, I

1511
00:58:02,403 --> 00:58:02,603
THINK.

1512
00:58:02,603 --> 00:58:05,272
SO THANK YOU.

1513
00:58:05,272 --> 00:58:07,007
>> BRILLIANT, JON.

1514
00:58:07,007 --> 00:58:09,743
WE'RE COMING TO THE CLOSE OF OUR

1515
00:58:09,743 --> 00:58:11,512
HOUR, AND I WANTED TO BE

1516
00:58:11,512 --> 00:58:15,049
SENSITIVE OF EVERYONE'S TIME.

1517
00:58:15,049 --> 00:58:17,885
I ALSO WANT TO THANK YOU

1518
00:58:17,885 --> 00:58:21,622
IMMENSELY FROM ALL OF US AT NIH.

1519
00:58:21,622 --> 00:58:29,797
OUR OBSSR DIRECTOR JANE SIMONI,

1520
00:58:29,797 --> 00:58:31,632
JOSH GORDON, BECKY, THE CONCEPT

1521
00:58:31,632 --> 00:58:32,733
TEAM AND ALL THE PARTICIPANTS

1522
00:58:32,733 --> 00:58:34,668
FOR YOUR INTELLECT AND YOUR

1523
00:58:34,668 --> 00:58:35,402
TIME.

1524
00:58:35,402 --> 00:58:37,938
I HOPE THEY'VE TAKEN THE QR CODE

1525
00:58:37,938 --> 00:58:40,007
YOU SHOWED EARLIER.

1526
00:58:40,007 --> 00:58:42,343
I BROUGHT UP THIS SLIDE SO

1527
00:58:42,343 --> 00:58:45,513
FOLKS, IF THEY MISSED IT, CAN

1528
00:58:45,513 --> 00:58:52,720
TAKE A PHOTO OF YOUR PROFILE AT

1529
00:58:52,720 --> 00:58:53,354
U-KENT.

1530
00:58:53,354 --> 00:58:54,522
I COULDN'T HAVE ASKED, NONE OF

1531
00:58:54,522 --> 00:58:56,056
US COULD HAVE EXPECTED SUCH A

1532
00:58:56,056 --> 00:58:57,391
GREAT WAY TO BEGIN THIS SERIES,

1533
00:58:57,391 --> 00:58:59,059
AND WE LOOK FORWARD TO WORKING

1534
00:58:59,059 --> 00:59:01,028
WITH FUTURE SCHOLARS AND

1535
00:59:01,028 --> 00:59:04,431
BRINGING YOU BACK TO HELP US

1536
00:59:04,431 --> 00:59:06,767
DEVELOP THIS LINE OF WORK MORE

1537
00:59:06,767 --> 00:59:08,836
THOROUGHLY.

1538
00:59:08,836 --> 00:59:11,672
THANKS TO YOU ALL FOR WATCHING,

1539
00:59:11,672 --> 00:59:14,742
AND LOOK FOR MORE FROM US IN

1540
00:59:14,742 --> 00:59:15,075
THIS REGARD.

1541
00:59:15,075 --> 00:59:16,410
THANK YOU SO MUCH.

1542
00:59:16,410 --> 00:59:16,644
CHEERS.

1543
00:59:16,644 --> 00:59:18,946
THANK YOU ALL VERY MUCH FOR

1544
00:59:18,946 --> 00:59:19,947
COMING ALONG AND FOR HAVING ME

1545
00:59:19,947 --> 00:59:21,015
ON.

1546
00:59:21,015 --> 00:59:22,449
IT'S BEEN A GREAT PLEASURE.

1547
00:59:22,449 --> 00:59:22,683
THANKS.

1548
00:59:22,683 --> 00:59:24,251
THANK YOU SO MUCH, JON.

1549
00:59:24,251 --> 00:59:28,956
TAKE CARE.

1550
00:59:28,956 --> 00:59:39,099
>> BYE.