195 Hierarchies: A Systematic Database Update
The database of evidence hierarchies has been updated based on a new systematic review of the medical literature, and now contains over 195 hierarchies.
Tag: Evidence
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 …
All that Glitters is not… Evidence
Recently, I wrote about a new machine learning model called GPT-2 which was conspicuously not released by OpenAI. GPT-2 is a massive language model which can be used to generate often highly convincing text when given a prompt. Using the ‘attention’ framework, the language model is able to produce compelling …
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 …
Echoes of Evidence
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 …
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 …
Medicine Needs Diverse Evidence
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 …