{"id":184,"date":"2024-04-10T12:43:57","date_gmt":"2024-04-10T11:43:57","guid":{"rendered":"https:\/\/blogs.kent.ac.uk\/wilde\/?page_id=184"},"modified":"2025-01-31T19:49:04","modified_gmt":"2025-01-31T19:49:04","slug":"evidence-based-medicine-ebm-the-hierarchy-of-evidence","status":"publish","type":"page","link":"https:\/\/blogs.kent.ac.uk\/wilde\/sample-page\/reading-lists\/evidence-based-medicine-ebm-the-hierarchy-of-evidence\/","title":{"rendered":"Evidence-Based Medicine (EBM): The Hierarchy of Evidence"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><u>EBM<\/u><\/p>\n<p>[1] Guyatt, G., <em>et al<\/em>. (1992) Evidence-based medicine: A new approach to teaching the practice of medicine. <em>JAMA<\/em>, 268(1): 2420-5.<\/p>\n<ul>\n<li>An article providing an early introduction and definition to Evidence-Based Medicine (EBM).<\/li>\n<\/ul>\n<p>[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\u2019t. <em>British Medical Journal<\/em>, 312: 71-2.<\/p>\n<ul>\n<li>An article giving a more nuanced definition of EBM, in response to early objections to EBM.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><u>The Hierarchy of Evidence<\/u><\/p>\n<p>[3] Clarke, B., Gillies, D, Illari, P., Russo, F., and J. Williamson. (2014) Mechanisms and the evidence hierarchy. <em>Topoi<\/em>, 33: 339-60.<\/p>\n<ul>\n<li>An article discussing the role of evidence of mechanisms in the hierarchy of evidence.<\/li>\n<\/ul>\n<p>[4] Howick, J. (2011) <em>The Philosophy of Evidence-Based Medicine.<\/em> Oxford: Wiley-Blackwell.<\/p>\n<ul>\n<li>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.<\/li>\n<\/ul>\n<p>[5] Worrall, J. (2007) Evidence in medicine and Evidence-Based Medicine. <em>Philosophy Compass<\/em>, 2(6): 981-1022.<\/p>\n<ul>\n<li>An article taking a critical look at the hierarchy of evidence.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><u>Mechanistic reasoning<\/u><\/p>\n<p>[6] Howick, J. (2011) Exposing the vanities\u2014and a qualified defence\u2014of mechanistic reasoning in health care decision making. <em>Philosophy of Science<\/em>, 78(5): 926-40.<\/p>\n<ul>\n<li>An article mostly criticising mechanistic reasoning, but also proposing some conditions on high quality mechanistic reasoning.<\/li>\n<\/ul>\n<p>[7] Solomon, M. (2015) <em>Making Medical Knowledge<\/em>. Oxford, UK: Oxford University Press.<\/p>\n<ul>\n<li>A book that discusses various methods in contemporary medicine. Chapters 5-6 discuss EBM. Chapter 5 in particular discusses mechanistic reasoning.<\/li>\n<\/ul>\n<p>[8] Wilde, M. (2021) Mechanistic reasoning and the problem of masking. <em>Synthese<\/em>, 199: 6103-18.<\/p>\n<ul>\n<li>An article that argues that it is difficult for there to be conditions for high quality mechanistic reasoning.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><u>Patient values in Evidence-Based Medicine<\/u><\/p>\n<p>[9] Kelly, M.P., Heath, I., Howick, J., Greenhalgh, T. (2016) The importance of values in evidence-based medicine. <em>BMC Medical Ethics<\/em>, 16:69.<\/p>\n<ul>\n<li>An article giving some examples to argue for the importance of incorporating patients&#8217; values into EBM.<\/li>\n<\/ul>\n<p>[10] Fulford, K.W.M., Peile, E., Carroll, H. (2012) <em>Essential Values-Based Practice: Clinical Stories Linking Values with People<\/em>. Cambridge, UK: Cambridge University Press.<\/p>\n<ul>\n<li>A book introducing&#8211;and training clinicians in&#8211;values-based practice by considering particular clinical encounters.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><u>EBM+<\/u><\/p>\n<p>[11] Greenhalgh,\u00a0T.,\u00a0Fisman,\u00a0D.,\u00a0Cane,\u00a0D.J.<em>, <\/em>Oliver, M., and C.R. Macintyre (2022) Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent <em>BMJ Evidence-Based Medicine<\/em>, 27:<em>\u00a0<\/em>253-60.<\/p>\n<ul>\n<li>An article arguing that the pandemic would have been better managed with an EBM+ approach.<\/li>\n<\/ul>\n<p>[12] Wilde, M. (2023) The EBM+ Movement. <em>International Journal of Biostatistics<\/em>, 19(2): 283-93.<\/p>\n<ul>\n<li>An article giving an introduction to&#8211;and motivation for&#8211;the EBM+ approach.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><u>External validity<\/u><\/p>\n<p>[13] Cartwright, N. (2011) The art of medicine: a philosopher\u2019s view of the long road from RCTs to effectiveness. <em>The Lancet<\/em>, 377: 1400-1.<\/p>\n<ul>\n<li>An article discussing the difficulties with applying the results of randomised controlled trials (RCTs) to individual patients.<\/li>\n<\/ul>\n<p>[14] Petticrew, M. and I. Chalmers. (2011) Use of research evidence in practice. <em>The Lancet<\/em>, 378: 1696.<\/p>\n<ul>\n<li>An article attempting to address the difficulties with applying the results of RCTs to individual patients.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; 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 [&hellip;]<\/p>\n","protected":false},"author":40779,"featured_media":0,"parent":181,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/pages\/184"}],"collection":[{"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/users\/40779"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/comments?post=184"}],"version-history":[{"count":6,"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/pages\/184\/revisions"}],"predecessor-version":[{"id":211,"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/pages\/184\/revisions\/211"}],"up":[{"embeddable":true,"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/pages\/181"}],"wp:attachment":[{"href":"https:\/\/blogs.kent.ac.uk\/wilde\/wp-json\/wp\/v2\/media?parent=184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}