Healthcare and Medicine Reference
mentioned in our Author's Welcome and Introduction are just two of the many
helpful areas. We must be open to them and adapt them in a well-structured way
to manage health problems. In fact, medicine is also a health business battle-
field where beyond health economics, our care and its outcomes must take into
account the money that passes between the health producer, supplier, and pro-
vider (health professionals, hospitals, medical offices or community medicine and
public health units, etc.) and the consumer, patients, and our community.
For lawyers, judges, and expert witnesses in courts of law, pleading for a
health cause is (and should be) an exercise in argumentation (inquiry and advo-
cacy) 72,73 and critical thinking as it has been outlined here for health sciences.
In this diversity of experience, we cannot insist enough on clear, usable,
and operational definitions of what we see and do. Again, orismology helps.
◾ An EBM practitioner may define evidence as “any data or information,
whether solid or weak, obtained through experience, observational
research, or experimental work (clinical or field trials), relevant to some
degree (more is better) either to the understanding of the problem (case)
or to the clinical and community medicine decisions made about the
case (meaning clinical case or the community health problem to solve).” 15
◾ For a philosopher/critical thinker , evidence is “the data on which a
judgment or conclusion might be based or by which proof or probabil-
ity might be established … something to prove.” 6
◾ For lawyers , as might be expected, evidence is “information and things
pertaining to the events that are the subject of an investigation or a
case: especially, the testimony or objects (but not the questions or com-
ments of the lawyers) offered at a trial or hearing for the judge or the
jury to consider in deciding the issue in a case.” 72
Grading evidence in EBM is based most often on the validity of different types
of studies as cause-effect proofs, from the least convincing to the most convinc-
ing: Narratives, single case observations, case series (no denominators, no control
groups) → observational analytical studies (cohort studies, case control studies)
→ experimental studies (clinical trials, etc.) → systematic reviews, meta-analyses,
and otherwise synthesized experimental and clinical experience and research of
observational analytical or experimental experience from multiple studies.
Grading evidence remains an unfinished topic and the subject of further
development, refinement, and expansion.
In various versions, the following “pyramid of evidence” can be found
across the current literature: