Does reductio ad absurdum have a place in evidence-based medicine?

Florian Naudet (1, 2) , Bruno Falissard (2)

1 Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes]
2 UMR_S 669 - Troubles du comportement alimentaire de l'adolescent

In a meta-analysis published in BMC Medicine, we explored whether evidence-based medicine can actually be sure that 'sucrose = sucrose' in the treatment of depression. This paper, based upon a reductio ad absurdum, addressed an epistemological question using a 'scientific' approach, and could be disconcerting as suggested by Cipriani and Geddes' commentary. However, most papers are based upon a mixture of observations and discussions about sense and meaning. Ultimately, there is nothing more than a story, told with words or numbers. Randomised controlled trials provide information about average patients that do not exist. These results ignores an entire segment of therapeutics that plays a crucial role, namely care. This information is usually set out using a 'grammar' that is ambiguous, since statistical tests of hypothesis have raised epistemological questions that are not as yet solved. Moreover, many of these stories remain untold, and unpublished. For these reasons evidence-based medicine is a vehicle for many paradoxes and controversies. Reductio ad absurdum can be useful in precisely this case, to underline how and why the medical literature can sometimes give an impression of absurdity of this sort. Even if the data analysis in our paper was rather rhetorical, we agree that it should comply with the classic standards of reporting and we provide the important extra data that Cipriani and Geddes have requested.

Mots clés: Epistemology; Evidence-based medicine; Publication bias; Reductio ad absurdum; Statistics

Domaines: Médecine humaine et pathologie

Florian Naudet, Bruno Falissard. Does reductio ad absurdum have a place in evidence-based medicine?. BMC Medicine, 2014, 12 (1), pp.106. ⟨10.1186/1741-7015-12-106⟩. ⟨hal-01070514⟩