Causality, mathematical models and statistical association: dismantling evidence-based medicine

Area of Science:

• Medical research methodology
• Philosophy of science

Background:

• The evidence-based medicine (EBM) movement has gained global prominence over 25 years.
• Randomized controlled trials (RCTs) are considered the 'gold standard' in EBM's evidence hierarchy.
• Recent years have seen significant criticism directed at RCTs.

Purpose of the Study:

• To critically evaluate the foundational role of RCTs within EBM.
• To examine the impact of mathematical application in RCTs on the validity of causal claims.
• To challenge the 'gold standard' status of RCTs in EBM.

Main Methods:

• Review and synthesis of existing criticisms of RCTs.
• Philosophical analysis of the role of mathematics in scientific inquiry.
• Comparative analysis of EBM's approach versus other scientific disciplines.

Main Results:

• RCTs utilize mathematics primarily as an analytical tool, not as a fundamental scientific language.
• This approach to mathematics in RCTs potentially undermines the validity of causal inferences.
• EBM's devaluation of theoretical models, unlike in physics or biology, weakens its knowledge claims.

Conclusions:

• The reliance on RCTs and the mathematical approach within EBM may compromise the robustness of its findings.
• EBM's current hierarchy of evidence requires re-evaluation.
• The validity of EBM's causal and knowledge claims is questionable and falls short of a 'gold standard'.