David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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European Journal for Philosophy of Science 1 (3):451-466 (2011)
Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical literature. It finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context
|Keywords||Evidence-based medicine Philosophy of medicine Kuhnian paradigm Nancy Cartwright Randomized controlled trial Translational medicine Evidence hierachy Meta-analysis John Ioannidis John Worrall|
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References found in this work BETA
R. E. Ashcroft (2004). Current Epistemological Problems in Evidence Based Medicine. Journal of Medical Ethics 30 (2):131-135.
Robyn Bluhm (2005). From Hierarchy to Network: A Richer View of Evidence for Evidence-Based Medicine. Perspectives in Biology and Medicine 48 (4):535-547.
N. Cartwright, A. Goldfinch & J. Howick (2009). Evidence-Based Policy: Where is Our Theory of Evidence? Journal of Children’s Services 4 (4):6--14.
Nancy Cartwright (2007). Are Rcts the Gold Standard? Biosocieties 1:11-20.
Nancy Cartwright (2009). Evidence-Based Policy: What's to Be Done About Relevance? [REVIEW] Philosophical Studies 143 (1):127 - 136.
Citations of this work BETA
Brendan Clarke, Donald Gillies, Phyllis Illari, Federica Russo & Jon Williamson (forthcoming). Mechanisms and the Evidence Hierarchy. Topoi:1-22.
Jesper Jerkert (2013). Jeremy Howick The Philosophy of Evidence‐Based Medicine.Wiley‐Blackwell & BMJ Books, 2011. Xiv + 229 Pp. ISBN 978‐1‐4051‐9667‐3 (Paperback). [REVIEW] Theoria 79 (2):180-186.
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