Pragmatism in Medicine
During the 1870s, Charles Sanders Peirce developed some of the earliest pragmatism ideas. He used pragmatism as both the name of a maxim and as the name of a method. Pragmatics is a philosophical theory that is concerned with the practical aspects of human action. Its goal is to understand how a person’s actions can lead to meaning. It also explores how language can be used to achieve meaning and negotiation. It is a study of how the meaning of an utterance is constructed, and its effect on the listener and speaker.
Pragmatics also considers the construction of implied meanings. A pragmatist is someone who is influenced by practical considerations. People who are pragmatic are usually hard-headed, sensible, and positive. They are often complimented for their practicality and good judgment. They are guided by their experience in making decisions.
Pragmatism is often referred to as a third alternative to “Continental” and “Analytic” philosophy. The term “pragmatic” comes from the Greek word for “practical” and “sensible,” and relates to the practice of problem solving. Its key ideas originated in Harvard Metaphysical Club discussions around 1870. Its intellectual center of gravity has recently shifted out of the United States. Its influence is now evident in central Europe, Scandinavia, and China. Its influence is expanding into the social sciences and ethics.
In medicine, pragmatic randomized controlled trials are often used by industry to inform reimbursement discussions, and decision makers. The trials can help remove biases that are introduced by the absence of randomization. They can also help remove biases related to routine care. They can also help to assess other types of interventions. For example, trials of non-regulated interventions can closely mimic real-world approaches to flexibility.
Trials that are highly pragmatic are likely to have high domain scores. These scores measure how well the trial reflects the complexities of care delivery, and how the study relates to routine care and organizational care. For example, trials of non-regulated intervention may be highly pragmatic because they closely mimic the real-world approach to flexibility. This will allow for more accurate and reliable assessment of the intervention.
Trials that are highly pragmatic also demonstrate the validity of a trial, which may be difficult to determine without a full protocol. A trial that is highly pragmatic is likely to be conducted by a single center, and it may be placebo-controlled. It may also include trials that are pre-licensing, which may have been performed before the medicine was licensed.
A trial of a non-regulated intervention may be highly pragmatic if it is closely replicating a real-world approach to recruitment, follow-up, or flexibility. It can also be highly pragmatic if the trial captures routine care, and if it is based on the evidence of the clinical trial and not the patient’s perspective.
A pragmatic trial is often mislabeled as a trial that is biased because it overtly deviates from usual care. It is also important to consider whether the trial was designed with the intent of conveying a misleading message to the patients. Without the full protocol, it is impossible to determine whether the trial was designed with the intent of gathering real-world evidence.