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Evidence and Hypothesis in Clinical Medical Science pp 101–127Cite as

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

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

Abstract

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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Notes

  1. 1.

    Greenhalgh cites Guyatt et al. (1995) in connection with this listing. Also, as she notes, this schema does not include qualitative research, which also may be of importance (Greenhalgh 2010, 163–176).

  2. 2.

    The problem being alluded to here is very real, but it is a general one: in conducting any scientific study, it is possible that one or more factors, unknown to the investigator(s), may be present and produce a distortion in one or more outcome measures. “Fixing” a factor usually is done purposely to minimize or eliminate a bias, for example, age-matching. The problem, per se, is not confined to randomization or RCTs, hence is not an argument against these methods. It is, of course, one reason why more than one study is highly desirable in some cases.

  3. 3.

    Howson and Urbach (2006, 197) state (and I believe most would agree) that the strong claim is indefensible.

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  1. Birmingham Radiological Group, Birmingham, AL, USA

    John Alexander Pinkston

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Pinkston, J.A. (2020). Justification for the Hierarchical Pyramid of Evidence-Based Medicine and a Defense of Randomization. In: Evidence and Hypothesis in Clinical Medical Science. Synthese Library, vol 426. Springer, Cham. https://doi.org/10.1007/978-3-030-44270-5_7

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