The Hierarchy of Evidence, Meta-Analysis, and Systematic Review

Authored by: Robyn Bluhm

The Routledge Companion to Philosophy of Medicine

Print publication date:  October  2016
Online publication date:  October  2016

Print ISBN: 9781138846791
eBook ISBN: 9781315720739
Adobe ISBN: 9781317519850


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Contemporary medical practice is strongly influenced by the idea that clinical decision-making should be based on the results of clinical trials. A number of interrelated trends, stretching back several decades, have converged on a view of what counts as good medical research. This chapter begins with a brief history of three connected movements—clinical epidemiology, evidence-based medicine (EBM), and the Cochrane Collaboration—which aim to promote the use of high-quality evidence from clinical research in patient care. “High-quality evidence” is usually understood as evidence at the top of a “hierarchy of evidence,” specifically randomized controlled trials (see Chapter 18) and systematic reviews or meta-analyses of such studies. The remainder of the chapter will discuss these ideas in detail, examining both the arguments for and the criticisms of hierarchical rankings of study methods, and of the combination of research results in a meta-analysis.

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