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 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 …

UBL and Variation

I’ve argued that information about variation in treatment effects is vital for doctors, patients and regulators alike. This information does not come from RCTs. Nonetheless, we can acquire high-quality, compelling evidence of variation. The case studies I’ve presented in the last few years show this in action but don’t prove …

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 …