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On the Meaning of Medical Evidence Hierarchies

Jerkert, Jesper (2021) On the Meaning of Medical Evidence Hierarchies. Philosophy of Medicine, 2 (1). pp. 1-21. ISSN 2692-3963

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Evidence hierarchies are investigative strategies ordered with regard to the claimed strength of evidence. They have been used for a couple of decades in EBM, particularly in assessing evidence for treatment recommendations, but remain controversial. An under-investigated question is what the order in the hierarchy means. Four interpretations are discussed here. The two most credible are “typically stronger” or “ideally stronger.” The well-known GRADE framework seems to assume some “typically stronger” reading. Even if the interpretation of an evidence hierarchy were established, hierarchies are rather unhelpful for the task of evidence aggregation. Specifying the intended order relation may help to sort out disagreements.

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Item Type: Published Article or Volume
Jerkert, Jesperjerkert@kth.se0000-0001-9373-3067
Keywords: evidence-based medicine evidence hierarchy strength of evidence quality of evidence order relation evidence aggregation lexicographic ordering GRADE ceteris paribus RCT observational study
Subjects: Specific Sciences > Medicine > Clinical Trials
Depositing User: Professor Alex Broadbent
Date Deposited: 29 Aug 2022 14:18
Last Modified: 29 Aug 2022 14:18
Item ID: 21104
Journal or Publication Title: Philosophy of Medicine
Publisher: University Library System, University of Pittsburgh
Official URL:
DOI or Unique Handle: 10.5195/pom.2021.31
Subjects: Specific Sciences > Medicine > Clinical Trials
Date: 19 April 2021
Page Range: pp. 1-21
Volume: 2
Number: 1
ISSN: 2692-3963

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