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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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The Fallibility of Evidence-Based Medicine

The Fallibility of Evidence-Based Medicine

(p.133) 6 The Fallibility of Evidence-Based Medicine
Making Medical Knowledge

Miriam Solomon

Oxford University Press

Evidence-based medicine is designed to minimize bias. Several philosophers have argued that the methods of evidence-based medicine do not eliminate the possibility of bias and error. This chapter considers these arguments, and finds them less compelling than the empirical findings of John Ioannidis and others that randomized controlled trials and even meta-analyses are less replicable than expected. Moreover, observational trials are much closer than expected to randomized controlled trials in external validity. The quality of clinical trials is multidimensional and not appropriately captured by the usual linear hierarchy of evidence. Possible solutions for various sources of bias and error are also considered.

Keywords:   evidence-based medicine, EBM, meta-analysis, external validity, evidence hierarchy, hierarchy of evidence, randomized controlled trials, RCT, observational trials, John Ioannidis

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