The notion of causal evidence in medicine has been the subject of wide philosophical debate in recent years. The notion of evidence has been discussed mostly in connection with Evidence Based Medicine and, more in general, with the assessment of causal nexus in medical, and especially research contexts. “Manipulative evidence” is one of the notions of causal evidence that has stimulated much debate. It has been defined in slightly different ways, attributed different relevance, and recently placed at the core of Gillies’ “action-related theory of causality”, a view specifically meant to address causation in medicine. While in general sympathetic to Gillies’ account, and totally convinced of the relevance of manipulative evidence and different sorts of interventions in the biomedical sciences, we believe that some further qualifications are needed to allow the notion of manipulative evidence to better express features of medical practice. In particular, we provide some qualification of the role of “interventional evidence” proposed by Gillies, suggesting a distinction between “interventional evidence” and “evidence for interventions”. A case study from research on rare diseases is analyzed in depth and a multifaceted notion of manipulative evidence put forward that allows better understanding of what manipulations in medical contexts amount to and what their targets are.

中文翻译：

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操作证据和医疗干预：一些资格。

近年来，医学上的因果证据概念一直是哲学界广泛争论的主题。证据的概念主要与循证医学有关，更广泛地说，与医学尤其是研究环境中的因果关系评估有关。“操纵性证据”是因果证据的概念之一，引起了很多争论。它的定义方式略有不同，具有不同的相关性，并且最近成为Gillies的“行动相关因果关系理论”的核心，这种观点专门用于解决医学上的因果关系。尽管总体上同情Gillies的观点，并且完全相信操纵性证据和生物医学科学中各种干预措施的相关性，我们认为，还需要一些进一步的限定条件，以使操纵证据的概念更好地表达医学实践的特征。尤其是，我们对Gillies提出的“介入证据”的作用作了一定的限定，提出了“介入证据”和“干预证据”之间的区别。对来自罕见疾病研究的案例研究进行了深入分析，并提出了多方面的操纵证据概念，使人们可以更好地了解医学背景下的操纵行为及其目标是什么。建议区分“干预证据”和“干预证据”。对来自罕见疾病研究的案例研究进行了深入分析，并提出了多方面的操纵证据概念，使人们可以更好地了解医学背景下的操纵行为及其目标是什么。建议区分“干预证据”和“干预证据”。对来自罕见疾病研究的案例研究进行了深入分析，并提出了多方面的操纵证据概念，使人们可以更好地了解医学背景下的操纵行为及其目标是什么。