Evidence-Based Medicine (EBM): The Hierarchy of Evidence

 

EBM

[1] Guyatt, G., et al. (1992) Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA, 268(1): 2420-5.

  • An article providing an early introduction and definition to Evidence-Based Medicine (EBM).

[2] Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S. (1996) Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312: 71-2.

  • An article giving a more nuanced definition of EBM, in response to early objections to EBM.

 

The Hierarchy of Evidence

[3] Clarke, B., Gillies, D, Illari, P., Russo, F., and J. Williamson. (2014) Mechanisms and the evidence hierarchy. Topoi, 33: 339-60.

  • An article discussing the role of evidence of mechanisms in the hierarchy of evidence.

[4] Howick, J. (2011) The Philosophy of Evidence-Based Medicine. Oxford: Wiley-Blackwell.

  • A book giving a philosophical motivation to EBM. Most chapters discuss the hierarchy of evidence. Chapters 1-3 introduce EBM. Chapters 4-8 discuss the differences between observational studies and randomized trials. Chapters 9-11 discuss the role of mechanistic reasoning and clinical judgement.

[5] Worrall, J. (2007) Evidence in medicine and Evidence-Based Medicine. Philosophy Compass, 2(6): 981-1022.

  • An article taking a critical look at the hierarchy of evidence.

 

Mechanistic reasoning

[6] Howick, J. (2011) Exposing the vanities—and a qualified defence—of mechanistic reasoning in health care decision making. Philosophy of Science, 78(5): 926-40.

  • An article mostly criticising mechanistic reasoning, but also proposing some conditions on high quality mechanistic reasoning.

[7] Solomon, M. (2015) Making Medical Knowledge. Oxford, UK: Oxford University Press.

  • A book that discusses various methods in contemporary medicine. Chapters 5-6 discuss EBM. Chapter 5 in particular discusses mechanistic reasoning.

[8] Wilde, M. (2021) Mechanistic reasoning and the problem of masking. Synthese, 199: 6103-18.

  • An article that argues that it is difficult for there to be conditions for high quality mechanistic reasoning.

 

Patient values in Evidence-Based Medicine

[9] Kelly, M.P., Heath, I., Howick, J., Greenhalgh, T. (2016) The importance of values in evidence-based medicine. BMC Medical Ethics, 16:69.

  • An article giving some examples to argue for the importance of incorporating patients’ values into EBM.

[10] Fulford, K.W.M., Peile, E., Carroll, H. (2012) Essential Values-Based Practice: Clinical Stories Linking Values with People. Cambridge, UK: Cambridge University Press.

  • A book introducing–and training clinicians in–values-based practice by considering particular clinical encounters.

 

EBM+

[11] Greenhalgh, T., Fisman, D., Cane, D.J., Oliver, M., and C.R. Macintyre (2022) Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent BMJ Evidence-Based Medicine, 27: 253-60.

  • An article arguing that the pandemic would have been better managed with an EBM+ approach.

[12] Wilde, M. (2023) The EBM+ Movement. International Journal of Biostatistics, 19(2): 283-93.

  • An article giving an introduction to–and motivation for–the EBM+ approach.

 

External validity

[13] Cartwright, N. (2011) The art of medicine: a philosopher’s view of the long road from RCTs to effectiveness. The Lancet, 377: 1400-1.

  • An article discussing the difficulties with applying the results of randomised controlled trials (RCTs) to individual patients.

[154] Petticrew, M. and I. Chalmers. (2011) Use of research evidence in practice. The Lancet, 378: 1696.

  • An article attempting to address the difficulties with applying the results of RCTs to individual patients.