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 …

Machine Evidence: Trial by AI

Take a look at the following snippets from descriptions of clinical trials, thinking about how you’d rate the quality and strength of the evidence that comes from each: 1: We conducted a clinical trial in which erythropoietin (EPO) administration was administered daily to patients with severe acne resulting in clinically significant …

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 …

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 …

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 …