History of Medicine
5 pieces tagged History of Medicine.
The Pyramid Schema: The Origins and Impact of Evidence Pyramids
[This paper has been updated in 2026 from the 2022 preprint] Evidence pyramids are amongst the most recognisable artefacts of the Evidence-Based Medicine movement. Yet no study has established the origins of evidence pyramids, or analysed whether they offer any information beyond simple lists or tables. In this paper, I establish the origins of the first evidence pyramid and argue that the pyramidal turn is a retrograde step in evidence appraisal.
The Machine Scientists: Iatrophysics and Selective Scientific Realism
The Machine Scientists - Giovanni Borelli, Jan Swammerdam and Niels Steensen - followed Rene Descartes in modelling the human body mechanically. The scientific success of this 'iatrophysical' programme, replete with rejected entities such as 'Animal Spirits', poses a problem for Scientific Realism. Using Psillos' moderate realism, this paper attempts to reconcile a selective realist position with the historical record.
Are hierarchies history?
Even if the hierarchies of evidence are on their way out in EBM in theory, they could still be enjoying the spotlight in practice.
Random Reflections: Cochrane and the Origins of Hierarchies
In 1972, Archie Cochrane publishedEffectiveness and Efficiency: Random Reflections on Health Services. In a little under 86 pages, Cochrane offers a wide-ranged but succinct delivery of his experience and his philosophy of evidence in clinical practice. It's a fascinating...
A Ghost of Progress - How Hierarchies Become Fixtures
I have written extensively on hierarchies of evidence in evidence-based medicine. The origin story of hierarchies of evidence is a little contentious. Several sources in EBM cite Campbell and Stanley's 1963 classic "Experimental and Quasi-experimental Designs for Research" as...