Evidence-based medicine must be ...

La Caze, Adam (2009) Evidence-based medicine must be .... The Journal of Medicine and Philosophy: a forum for bioethics and philosophy of medicine, 34 5: 509-527. doi:10.1093/jmp/jhp034

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Author La Caze, Adam
Title Evidence-based medicine must be ...
Journal name The Journal of Medicine and Philosophy: a forum for bioethics and philosophy of medicine   Check publisher's open access policy
ISSN 0360-5310
1744-5019
Publication date 2009-10-01
Sub-type Article (original research)
DOI 10.1093/jmp/jhp034
Volume 34
Issue 5
Start page 509
End page 527
Total pages 19
Editor Cherry, M. J.
Englehardt, H. T.
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Subject C1
220205 History and Philosophy of Medicine
970111 Expanding Knowledge in the Medical and Health Sciences
970122 Expanding Knowledge in Philosophy and Religious Studies
Abstract Proponents of evidence-based medicine (EBM) provide the “hierarchy of evidence” as a criterion for judging the reliability of therapeutic decisions. EBM’s hierarchy places randomized interventional studies (and systematic reviews of such studies) higher in the hierarchy than observational studies, unsystematic clinical experience, and basic science. Recent philosophical work has questioned whether EBM’s special emphasis on evidence from randomized interventional studies can be justified. Following the critical literature, and in particular the work of John Worrall, I agree that many of the arguments put forward by advocates of EBM do not justify the ambitious claims that are often made on behalf of randomization. However, in contrast to the recent philosophical work, I argue that a justification for EBM’s hierarchy of evidence can be provided. The hierarchy should be viewed as a hierarchy of comparative internal validity. Although this justification is defensible, the claims that EBM’s hierarchy substantiates when viewed in this way are considerably more circumscribed than some claims found in the EBM literature.
Keyword Bias
Evidence-based medicine (EBM)
Randomization
Randomized controlled trial
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Pharmacy Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 22 times in Scopus Article | Citations
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Created: Tue, 10 Nov 2009, 20:06:22 EST by Charna Kovacevic on behalf of School of Pharmacy