Systematic Review

One of the things coming from reading the main EBM texts (Guyatt and Sackett) is the lack of pathophysiological rationale in the interpretation of evidence.

This questions the interpretation of the hierarchy as only being about therapeutic questions—i.e. therapeutic question first; then look for evidence—this interpretation permits an important role for pathophys when it comes to interpretation of higher forms of evidence. This seems to provide some evidence that the EBM proponents do view the hierarchy as a free standing epistemology.

There does not seem to be a recognition that pathophysiology can provide a principled account of differences in trial outcomes.

If this is the case, I would suspect there are examples where systematic reviews and meta-analyses combine data from studies where there are highly plausible pathophysiological stories for differences. Meta-analyses which do this would blur the truth rather than uncover it. This could be tested empirically or done with case studies.

[[crimson Very interesting indeed. And there’s an interesting historical background to all this in the debate — which long precedes EBM — about “black-boxed” epidemiological evidence. Jason ]]