David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Philosophy, Ethics, and Humanities in Medicine 3 (1):23 (2008)
The ideology of evidence-base medicine (EBM) has dramatically altered the way we think, conceptualize, philosophize and practice medicine. One of its major pillars is the appraisal and classification of evidence. Although important and beneficial, this process currently lacks detail and is in need of reform. In particular, it largely focuses on three key dimensions (design, [type I] alpha error and beta [type II] error) to grade the quality of evidence and often omits other crucial aspects of evidence such as biological plausibility, reproducibility, generalizability, temporality, consistency and coherence. It also over-values the randomized trial and meta-analytical techniques, discounts the biasing effect of single centre execution and gives insufficient weight to large and detailed observational studies. Unless these aspects are progressively included into systems for grading, evaluating and classifying evidence and duly empirically assessed (according to the EBM paradigm), the EBM process and movement will remain open to criticism of being more evidence-biased than evidence-based
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Roger Kerry, Thor Eirik Eriksen, Svein Anders Noer Lie, Stephen Mumford & Rani Lill Anjum (2012). Causation and Evidence-Based Practive - an Ontological Review. Journal of Evaluation in Clinical Practice 18 (5):1006-1012.
Sarah J. L. Edwards (2011). Assessing the Remedy: The Case for Contracts in Clinical Trials. American Journal of Bioethics 11 (4):3-12.
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