195 Hierarchies: A Systematic Database Update
The database of evidence hierarchies has been updated based on a new systematic review of the medical literature, and now contains over 195 hierarchies.
Category: Evidence-Based Medicine
5 years: Hierarchies of Evidence in Evidence-Based Medicine
In the five years since the publication of Hierarchies of Evidence in Evidence-Based Medicine, what has changed and what lessons can philosophers learn?
Are hierarchies history?
Throughout my career as a philosopher of medicine, I have taken a special interest in hierarchies of evidence as used in Evidence-Based Medicine (EBM) and beyond. My critique of evidence hierarchies has adapted and developed alongside recent movements towards a less rigid hierarchalism in EBM, and with the development of …
Random Reflections: Cochrane and the Origins of Hierarchies
In 1972, Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services. In a little under 86 pages, Cochrane offers a wide-ranged but succinct delivery of his experience and his philosophy of evidence in clinical practice. It’s a fascinating gallop through the concerns of one of the most influential figures …
A Ghost of Progress – How Hierarchies Become Fixtures
I have written extensively on hierarchies of evidence in evidence-based medicine. The origin story of hierarchies of evidence is a little contentious. Several sources in EBM cite Campbell and Stanley’s 1963 classic “Experimental and Quasi-experimental Designs for Research” as containing the first hierarchy, or at least the germ of the …
The Dismal Disease: Temozolomide and the Interaction of Evidence
“I think the challenge is really that we still, not only in glioblastoma, but in oncology at large, treat the majority of patients with a one-size-fits-all approach.” — Roger Stupp Blockbuster drugs are rare. To be a blockbuster, a drug must shift over $1bn worth in one year. There …
Stop Fighting, You’re Making Me SAD
Does medical science have to be adversarial to make progress? Does progress in patient care consist of weeding out treatments which are ineffective and replacing existing therapies with new and better alternatives? Subacromial Decompression (SAD) surgery is one of the most commonplace shoulder surgeries, performed regularly as a treatment for …
Echoes of Evidence
Do you have an idea of what makes good medical evidence in your mind? Do you have ideas about the kind of evidence you’d pay attention to, and the kind of evidence you can safely disregard? Or ideas about the evidence that would strongly sway your beliefs and actions, and …
The Authority of Evidence-Based Medicine
In the early part of the 20th century, the philosopher Ludwig Wittgenstein sought to demonstrate that metaphysical claims are meaningless. Statements which couldn’t be proven true in some way—through logic or evidence—weren’t even false, they had no meaning at all. But he ran up against a problematic irony. His book, …
The Positivity Machine: “Evidence-Based Alternative Medicine” and Grades of Recommendation
By definition, I begin, Alternative Medicine, I continue, Has either not been proved to work, or been proved not to work. Do you know what they call alternative medicine that’s been proved to work? Medicine. —Tim Minchin, Storm In his beat-poem Storm, the musician and comedian Tim Minchin lays …