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 …

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 …

The Disunity of Evidence-Based Medicine

Critics and advocates alike have expended much effort defining Evidence-Based Medicine. However, there has been little consensus about what “Evidence-Based Medicine” is. Some authors see ‘EBM’ as something one believes—a view about medicine. Others interpret EBM as something one does—a particular way of practicing medicine. Still others seem to view …