The Avoidable Scandal: Benoxaprofen and Theories of Medical Evidence

“This debate is about Britain’s greatest drug disaster. It is about the scandal of a huge United States pharmaceutical company coming to Britain and boasting of Opren, a new wonder drug to treat arthritis — with tragic results.” —Lord Jack Ashley Benoxaprofen, marketed as Opren in the UK, created a …

UBL and Variation

I’ve argued that information about variation in treatment effects is vital for doctors, patients and regulators alike. This information does not come from RCTs. Nonetheless, we can acquire high-quality, compelling evidence of variation. The case studies I’ve presented in the last few years show this in action but don’t prove …

The Dismal Disease: Temozolomide and the Interaction of Evidence

An abridged version of this article is also available here.   Blockbuster drugs are rare. To be a blockbuster, a drug must shift over $1bn worth per year. There are thousands of drugs on the market, but only a few hundred blockbusters. Yet between them, they make up more than …

Pluralism and the Problems of Demarcation

In 1983, Larry Laudan proclaimed the “Demise of the Demarcation Problem” (Laudan 1983). I will argue that the ‘simple demarcation’ problem should indeed be abandoned. However, abandoning the quest for simple demarcation does not entail that demarcation problems are intractable. Though the dream of a single criterion to demarcate ‘science’ …

Hierarchies of Evidence: Database of Hierarchies

Hierarchies of Evidence are a tool employed by many advocates of Evidence-Based Medicine. They are used to appraise evidence from a range of sources, as well as to teach medical students about evidence and evidence appraisal. My PhD thesis concerns the variation in hierarchies defended, and the range of philosophical …

Two Dogmas of Evidence Hierarchies

Hierarchies of evidence in Evidence-Based Medicine (EBM) come in many varieties and have been very influential in medical practice and policy since the late 1990s. However, two fundamental problematic assumptions underpin the use of hierarchies of any kind in clinical practice: (1) that evidence can and should be appraised in …