Theory-Based Medicine and the Role of Evidence: Why the Emperor Needs New Clothes, Again
Bibliographic record
Abstract
The evidence-based medicine (EBM) movement was established to combat capricious reasoning in clinical care, particularly arguments from authority. Critique of authority and appraisal of evidence remain EBM's core values and should be revisited in this era of EBM's maturity and influence. We are now faced with a new form of under-questioned authority: evidence from well-designed and methodologically appraised randomized controlled trials (RCTs). RCT evidence is now prized even when it is incapable of providing meaningful information-in particular, when underlying causal theory is inscrutable. Experimental trial evidence of the effectiveness of remote intercessory prayer provides an illustrative case that highlights systematic scientific blind spots in the institutions of EBM. Medicine-even evidence-based medicine-is theory-based at its core. EBM must cultivate greater capacity to address the crucial role of theory in both the generation and use of experimental evidence.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.067 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.004 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".