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Title: The need to reform our assessment of evidence from clinical trials: a commentary.
Austin Authors: Bagshaw, Sean M;Bellomo, Rinaldo 
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
Issue Date: 30-Sep-2008
Publication information: Philosophy, Ethics, and Humanities in Medicine : Pehm 2008; 3(): 23
Abstract: The ideology of evidence-based 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."All scientific work is incomplete--whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time". (Sir Bradford Austin Hill 1).
Gov't Doc #: 18826605
DOI: 10.1186/1747-5341-3-23
Journal: Philosophy, ethics, and humanities in medicine : PEHM
Type: Journal Article
Subjects: Evidence-Based Medicine.standards
Meta-Analysis as Topic
Randomized Controlled Trials as Topic
Appears in Collections:Journal articles

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