Justification for the Hierarchical Pyramid of Evidence-Based Medicine and a Defense of Randomization

Part of the Synthese Library book series (SYLI, volume 426)


In this chapter I argue that the weight of evidence account justifies the “hierarchical pyramid” of study types often used by the Evidence-Based Medicine movement to rank evidence according to the degree of evidential support they afford. I also defend the need for randomization in randomized clinical trials against critics from the medical and philosophical communities, and explain why accuracy is thereby improved. I illustrate the process of how studies that are early and inconclusive progress to more definitive studies by considering the historical case of the evolution of treatments for early breast cancer. I argue that the weight of evidence account successfully explains why the earlier, lower level studies were insufficient and later, more definitive studies were necessary. I also argue that studies in clinical medical science are frequently more generalizable than critics seem to often assume.


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Birmingham Radiological GroupBirminghamUSA

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