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Evidence

What counts as proof, who decides that, and why the question has an answer in medicine that it lacks online.

Contents 44

Medicine spent forty years building a way to rank evidence. The web ranks by links.

Evidence is what turns a belief into knowledge. This page states what is settled about it, what the usual treatment leaves out, and what the apparatus built elsewhere would contribute here.

Every heading is a question. The answer stands directly under it, in plain words.

What is evidence?

Evidence is what makes a statement indubitable, through direct observation or through compelling inference. It is the ground on which a belief may be held. Everything else on this page concerns how that ground is tested.

What is epistemology?

Epistemology examines the conditions of knowledge, how it is acquired and where its limits lie. It is the field that asks what would have to be true for a claim to count as known. It is also the field that search systems now operate in without noticing.

What is the theory of knowledge?

The theory of knowledge concerns the foundations, limits and validity of human knowing. It supplies the standards the rest of this page applies. It is older than every measurement described here.

What is justification?

Justification is the epistemic ground that turns a mere belief into knowledge. Without it a true belief is an accident. It is the component that evidence supplies.

What is a belief?

A belief is a cognitive state of a person, whose truth is decided by reasons and evidence rather than by conviction. Holding something firmly has no bearing on whether it is so. The distinction is the whole of the subject.

What is certainty?

Certainty is a state produced by immediate evidence or compelling proof. It is a property of the knower rather than of the claim. Certainty and correctness come apart regularly.

What is truth here?

Truth is a necessary condition of knowledge and a predicate that marks statements. A false statement cannot be known, however well justified. That is the constraint everything else works under.

What is empirical evidence?

Empirical evidence rests on systematic observation and data collection. It is the form of evidence that can be gathered rather than seen. Most of what is disputed publicly is disputed at this level.

What is direct observation?

Direct observation serves in philosophy as a source of immediate insight. It appears to need no argument. It is also where theory-ladenness enters, which is treated below.

What is sense experience?

Sense experience is, for empiricist positions, the basic instance that turns the world into knowledge. It is the entry point of evidence. Its reliability is exactly what scepticism questions.

What is scepticism?

Scepticism questions the underlying system of evidence and doubts that the standards hold. It is the permanent opposition in this field. It is also the reason the standards were formalised at all.

What is inference?

Compelling inference produces mediated evidence from existing statements. It extends what is known beyond what is observed. Its validity is the subject of the science-theory pages in this field.

What is a randomised controlled trial?

A randomised controlled trial is a design that assigns participants by chance, in order to remove systematic differences between groups. It is treated as the most reliable single study type. It is the instrument that made evidence rankable.

What is a systematic review?

A systematic review gathers the available external evidence on a clearly bounded question, by an explicit procedure. It is a study of studies. It is the step at which individual results become a state of knowledge.

What is clinical expertise?

Clinical expertise is the judgment acquired through experience. It is the component that applies general evidence to a particular case. It is also where evidence-based practice is most often misunderstood as its opposite.

What is a gold standard?

A gold standard is the most reliable available benchmark for quality. It sets the level against which weaker evidence is measured. It exists because somebody built a ranking and defended it.

What does the usual treatment of evidence leave out?

It treats evidence as a positive condition: evidence justifies, justification makes knowledge. It leaves out everything that defeats, degrades or distorts evidence, everything probabilistic, and the entire institutional apparatus that decides in practice which evidence counts.

What is an epistemic defeater?

A defeater is a consideration that removes a justification without disproving the claim. Half of practical reasoning consists of defeaters.

What is pragmatic encroachment?

Pragmatic encroachment is the view that how much evidence you need depends on what turns on being wrong. In practice everybody already applies it.

What is epistemic luck?

Epistemic luck is arriving at a true belief by accident. Without the concept there is no way to separate a reliable method from a fortunate one.

What is degree of belief?

Degree of belief treats conviction as a quantity rather than as present or absent. Every real judgment is graded, and the binary model cannot represent it.

What is epistemic risk here?

Epistemic risk weighs the cost of error against the cost of caution. The cost is what decides how much evidence is enough.

What is peer disagreement?

Peer disagreement is the case of two equally competent people reaching different conclusions from the same evidence. The disagreement case is the one that arises in public.

What is Bayesian epistemology?

Bayesian epistemology models belief as probability and updates it with evidence. The formal treatment is the one that actually says how much a piece of evidence should move you.

What is a prior probability?

A prior probability is what you believed before the observation. The same evidence moves two people to different conclusions because their priors differ, and that is not an error.

What is underdetermination?

Underdetermination is the situation where the same data support several incompatible theories. Where evidence does not map onto one explanation, further data does not settle the matter.

What is falsifiability?

Falsifiability is the property of a claim that some observation could refute it. A claim that nothing could refute is not supported by the evidence that appears to support it.

What is the Duhem-Quine thesis?

The Duhem-Quine thesis holds that hypotheses are never tested alone, but always together with auxiliary assumptions. When a test fails, what failed is not identified by the test.

What is a likelihood ratio?

A likelihood ratio expresses how much more probable the observed data are under one hypothesis than under another. The number is what distinguishes strong evidence from a suggestive anecdote.

What is preregistration?

Preregistration fixes the hypothesis and the analysis before the data are seen. Without it, a confirmed prediction and a post-hoc explanation are indistinguishable in the report.

What is publication bias?

Publication bias is the tendency for positive findings to be published and null findings to remain unpublished. What is visible is therefore not a sample of what was done.

What is p-hacking?

P-hacking is the selective analysis that produces a significant result from data that do not contain one. It is a set of decisions, each defensible, that together manufacture a finding.

What is a replication study?

A replication study repeats an investigation independently. A result that has never been repeated is a hypothesis with a number attached.

What is an evidence hierarchy?

An evidence hierarchy ranks study designs by how much confidence they warrant. The ordering is what makes evidence usable by somebody who is not a specialist.

If citation counts tracked reliability, highly cited studies would hold up equally well whatever their design. The design made the difference.

Highly cited clinical studies later contradicted, by study design
Highly cited clinical study, by designClaimed an effectLater contradicted, or effect shown smaller
Nonrandomised studies65
Randomised controlled trials399
All4514

Ioannidis, J. P. A., Contradicted and initially stronger effects in highly cited clinical research, JAMA, 2005. Original clinical studies from 1990 to 2003, each cited more than 1,000 times.

What is a confounder?

A confounder is a third factor that produces an apparent relation between two others. Most spurious findings are confounding rather than fraud.

What is methodological triangulation?

Triangulation combines several independent methods on the same question. Agreement across methods that fail differently is worth more than repetition within one.

What is a meta-analysis?

A meta-analysis pools results from several studies quantitatively. The quantitative version produces an estimate with a stated uncertainty, which narrative synthesis cannot.

What is the GRADE system?

GRADE is a standardised scheme for rating the certainty of evidence and the strength of recommendations. It exists precisely so that assessment does not depend on who is assessing.

What is the Cochrane Collaboration?

Cochrane is the international body that produces systematic reviews to a fixed methodology. The institutions are what turned evidence-based practice from a principle into a routine.

What is a data monitoring committee?

A data monitoring committee reviews accumulating trial data independently of the investigators. The check exists because investigators cannot judge their own trial mid-flight.

What is the CONSORT statement?

CONSORT is the reporting standard for randomised trials, specifying what must appear in the publication. What is not reported cannot be assessed, whatever the study did.

What would this apparatus contribute to the web?

Medicine built a way to rank evidence, a scheme for rating certainty, institutions that apply it, and reporting standards that make assessment possible. The web ranks by links and mentions. Every element above exists, is documented, and has never been carried across.

What can a publisher take from this immediately?

State what a claim rests on, name the kind of evidence it is, and say what would change your mind. That is the portable core of the whole apparatus. It costs nothing and it is what distinguishes a source that can be checked from one that can only be believed.

Last revised 2026-09-16.