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 …

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 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 …

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 …

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 …