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 …

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 …

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 …

Pluralism and the Problems of Demarcation

In 1983, Larry Laudan proclaimed the “Demise of the Demarcation Problem” (Laudan 1983). I will argue that the ‘simple demarcation’ problem should indeed be abandoned. However, abandoning the quest for simple demarcation does not entail that demarcation problems are intractable. Though the dream of a single criterion to demarcate ‘science’ …

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 …