Throughout my career as a philosopher of medicine, I have taken a special interest in hierarchies of evidence as used in Evidence-Based Medicine (EBM) and beyond. My critique of evidence hierarchies has adapted and developed alongside recent movements towards a less rigid hierarchalism in EBM, and with the development of …
In 1972, Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services. In a little under 86 pages, Cochrane offers a wide-ranged but succinct delivery of his experience and his philosophy of evidence in clinical practice. It’s a fascinating gallop through the concerns of one of the most influential figures …
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 …
“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 …
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 …
Do you have an idea of what makes good medical evidence in your mind? Do you have ideas about the kind of evidence you’d pay attention to, and the kind of evidence you can safely disregard? Or ideas about the evidence that would strongly sway your beliefs and actions, and …
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, …
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 …
“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 …
Do not centralize evidence. If you believe that all the evidence you need to make your decisions is of a single kind, you will be so much easier to mislead. Those who say ‘I’ll believe it when I see this kind of study’, once their singular preference is declared, are …
