5 years: Hierarchies of Evidence in Evidence-Based Medicine
In the five years since the publication of Hierarchies of Evidence in Evidence-Based Medicine, what has changed and what lessons can philosophers learn?
Category: RCTs
Random Reflections: Cochrane and the Origins of Hierarchies
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 …
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 …
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 …
RCTs – a note on terminology
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 …