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The evidence that evidence-based medicine omits

Clarke, B; Gillies, D; Illari, P; Russo, F; Williamson, J; (2013) The evidence that evidence-based medicine omits. Preventive Medicine , 57 (6) 745 - 747. 10.1016/j.ypmed.2012.10.020. Green open access

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According to current hierarchies of evidence for EBM, evidence of correlation (e.g., from RCTs) is always more important than evidence of mechanisms when evaluating and establishing causal claims. We argue that evidence of mechanisms needs to be treated alongside evidence of correlation. This is for three reasons. First, correlation is always a fallible indicator of causation, subject in particular to the problem of confounding; evidence of mechanisms can in some cases be more important than evidence of correlation when assessing a causal claim. Second, evidence of mechanisms is often required in order to obtain evidence of correlation (for example, in order to set up and evaluate RCTs). Third, evidence of mechanisms is often required in order to generalise and apply causal claims. While the EBM movement has been enormously successful in making explicit and critically examining one aspect of our evidential practice, i.e., evidence of correlation, we wish to extend this line of work to make explicit and critically examine a second aspect of our evidential practices: evidence of mechanisms.

Type: Article
Title: The evidence that evidence-based medicine omits
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ypmed.2012.10.020
Publisher version: http://dx.doi.org/10.1016/j.ypmed.2012.10.020
Language: English
Additional information: Copyright 2013 Elsevier. This article is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0.
Keywords: Evidence-based medicine, Methods, Philosophy, Evidence hierarchy, RCT, Mechanism, Evidence
UCL classification: UCL > Office of the President and Provost
UCL > School of BEAMS
URI: http://discovery.ucl.ac.uk/id/eprint/1373878
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