This is a comments thread for John Worrall’s paper “Evidence in Medicine and Evidence-Based Medicine”:http://www.blackwell-compass.com/subject/philosophy/article_view?article_id=phco_articles_bpl106 in “Philosophy Compass”:http://www.blackwell-compass.com/subject/philosophy/. This article has been made free by Blackwell for the purpose of this thread. Here is the abstract.

bq. It is surely obvious that medicine, like any other rational activity, must be based on evidence. The interest is in the details: how exactly are the general principles of the logic of evidence to be applied in medicine? Focussing on the development, and current claims of the ‘Evidence-Based Medicine’ movement, this article raises a number of difficulties with the rationales that have been supplied in particular for the ‘evidence hierarchy’ and for the very special role within that hierarchy of randomized controlled trials (and meta-analyses of the results of randomized controlled trials). The point is not at all to question the application of a scientific approach to evidence in medicine, but, on the contrary, to indicate a number of areas where philosophers of science can contribute to a proper implementation of exactly that scientific-evidential approach.

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