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: Hierarchies of Evidence
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 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 …
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 interpretations of those hierarchies.
An information ordering thing
Randall Monroe of xkcd started writing explanations of complex physical phenomena using only the most common 1,000 English words (or the most common ‘ten hundred’, as he’d have to put it). He recently released a straightforward application which allows writers to check which words fall into his list of 1,000. I’ve …
The Exhaustiveness Problem
Hierarchies of evidence can be classified as exhaustive or inexhaustive. A hierarchy is exhaustive if and only if it gives some ranking to any given piece of medical evidence – there’s nothing it leaves out. But there’s a dilemma which hierarchy authors face: either way, hierarchies of evidence present a …
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 …