Evidence-Based Medicine Must Be ..

Journal of Medicine and Philosophy 34 (5):509-527 (2009)
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.
Keywords bias  randomization  randomized controlled trial  evidence-based medicine
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DOI 10.1093/jmp/jhp034
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References found in this work BETA
What Evidence in Evidence-Based Medicine?John Worrall - 2002 - Proceedings of the Philosophy of Science Association 2002 (3):S316-S330.
Why There's No Cause to Randomize.John Worrall - 2007 - British Journal for the Philosophy of Science 58 (3):451-488.
From Hierarchy to Network: A Richer View of Evidence for Evidence-Based Medicine.Robyn Bluhm - 2005 - Perspectives in Biology and Medicine 48 (4):535-547.
Evidence in Medicine and Evidence-Based Medicine.John Worrall - 2007 - Philosophy Compass 2 (6):981–1022.

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Citations of this work BETA
The Role of Basic Science in Evidence-Based Medicine.Adam la Caze - 2011 - Biology and Philosophy 26 (1):81-98.

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