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Making Medical Knowledge$
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Miriam Solomon

Print publication date: 2015

Print ISBN-13: 9780198732617

Published to Oxford Scholarship Online: June 2015

DOI: 10.1093/acprof:oso/9780198732617.001.0001

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Evidence-Based Medicine as Empiric Medicine

Evidence-Based Medicine as Empiric Medicine

(p.105) 5 Evidence-Based Medicine as Empiric Medicine
Making Medical Knowledge

Miriam Solomon

Oxford University Press

This chapter begins with an account of the development of the elements of evidence-based medicine: the randomized controlled trial, evidence hierarchies, meta-analysis, and systematic review. It discusses the relationship of evidence-based medicine to the medical decision-making movement. It focuses on one criticism of evidence-based medicine: the claim that evidence-based medicine ignores the basic sciences that guide both research and clinical practice. This is because evidence hierarchies put “pathophysiological reasoning” at the bottom, or leave it off the hierarchy altogether. Several philosophers of science suggest that this be remedied by adding some high-quality “mechanistic evidence” to the middle or upper levels of the evidence hierarchy. The chapter argues instead that we regard evidence-based medicine as only one of the methods needed in medicine.

Keywords:   evidence-based medicine, EBM, evidence hierarchy, randomized controlled trial, RCT, meta-analysis, pathophysiological reasoning, systematic review, medical decision making, MDM, mechanistic evidence

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