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 …
I spend a lot of my time talking to healthcare practitioners of all kinds about evidence, formally and informally. I’m mostly focused on getting the word out that RCT results are not the only thing that matters in treatment recommendations, that hierarchies of evidence are pretty weak ways to evaluate …
“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 …
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 …
Of late, a confusion has emerged in the diagnostic and philosophical literature concerning the ways in which diagnostic failure can occur. It’s rare to see clear attempts at a taxonomy of diagnostic failure. Here, I want to disambiguate a number of ways in which clinicians (and computer diagnostic aids) can …
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 …
Hierarchies of evidence in Evidence-Based Medicine (EBM) come in many varieties and have been very influential in medical practice and policy since the late 1990s. However, two fundamental problematic assumptions underpin the use of hierarchies of any kind in clinical practice: (1) that evidence can and should be appraised in …
Strength of Recommendation hierarchies such as SORT and GRADE go a step further than your standard hierarchy of evidence. Standard hierarchies tend to rank or rate the evidence provided by a study on a scale of quality, strength or validity. Strength of Recommendation hierarchies are usually two-step processes. First, they …
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 …
RCT is variously used to stand for one of two things: Randomised Controlled Trial Randomised Clinical Trial For the most part, when I’m talking about an RCT, it’s understood as a Randomised Clinical Trial, though I use them interchangeably because I can get away with it – but not everyone …
