The Parachute Problem: Extracorporeal Life Support and the Demand for Trials

“One of the best things about [extracorporeal life support] is that it acts as a parachute. It’s there when everything else fails and has known results”. Robert Bartlett   1: Parachutes and the Demand for Trials   The United States Parachute Association recorded 120 deaths while skydiving in America in …

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 …

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.

Against “Effective Treatments”

I am agitating for philosophers of medicine and philosophically-minded clinicians to lead the charge against the term “effective treatment”. This phrase has become ubiquitous in the medical and philosophical literature. But it is a misguided choice which misleads the public and practitioners alike. In general, I want to promote talk about …

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 …

Strength of Recommendation – the Rudner Problem

Strength of Recommendation hierarchies such as SORT and GRADE go a step further than your standard hierarchy of evidence. Standard hierarchies tend to rank or rate the evidence provided by a study on a scale of quality, strength or validity. Strength of Recommendation hierarchies are usually two-step processes. First, they …