‘All theKing's horses …’: the problematical fate of born‐again evidence‐based medicine: commentary onGreenhalgh,T.,Snow,R.,Ryan,S.,Rees,S., andSalisbury,H. (2015) six ‘biases’ against patients and carers in evidence‐based medicine.BioMedCentralMedicine, 13:200

Abstract

The phrase ‘evidence-based medicine (EBM)’ is being used by both EBM advocates and adversaries to broadly denote the production and use of clinical research throughout the healthcare system. Recently, this trend was joined by a call for a general expansion and rebirth of EBM to encompass a diverse range of healthcare activities otherwise corresponding to person-centred care. The call asserts that EBM is to blame for anti-patient biases within clinical practice and in policy and public health domains. Effective critique of either EBM or of the healthcare system requires that EBM itself be properly identified as a research literacy movement that grew out of clinical epidemiology of the 1970’s and 1980’s. We demonstrate the ineffectiveness of inappropriately targeted critiques of healthcare under the banner of born-again EBM.We identify the strengths and weaknesses of EBM as an educational movement drawing on the concept of literacy associated with the Brazilian educator Paolo Freire. We consider the relationship of EBM to clinical epidemiology and conclude that it cannot fruitfully divorce itself from the latter.We briefly consider existing precedents for philosophically sound conceptual platforms for advocacy of person-centred healthcare and broad based critique of the healthcare system including relationship-centred care. We conclude that traditional EBM, as a framework for research literacy training of both clinicians and policy makers, must continue to play a subsidiary role within an expanding patient-centred healthcare system and that advocacy efforts on behalf of patient voice and engagement are best pursued unencumbered by subsidiary agendas.

The multiple faces of practical wisdom in complex clinical practices: An empirical exploration

“…Another field of tension is that between the clinical need to individualize care, and the view of professional medical organizations, shared by external supervisory authorities, who emphasize the application of comprehensible standards and guidelines in practices, and carry on audits on this . These standards and guidelines adhere to a “Newtonian/mechanistic paradigm of ‘predictable cause and effect’ relationships,” even though daily reality is characterized by complexity and is therefore consistent with a very different paradigm.…”

From MARS to MAGIC: The remarkable journey through time and space of the Grading of Recommendations Assessment, Development and Evaluation initiative

“…Evidence‐based medicine (EBM) was introduced in 1991 and flourished through the 1990s as an innovation in medical education . By the end of the decade, EBM skills were well on the way to being incorporated into mandated undergraduate and graduate medical education requirements throughout North America, Europe, and the United Kingdom, a process that continues through this day.…”

Teaching by (bad) example: what a confused attempt to “advance” EBM reveals about its underlying problems: commentary on Jenicek, M. (2015). Do we need another discipline in medicine? From epidemiology and evidence‐based medicine to cognitive medicine and medical thinking. Journal of evaluation in clinical practice, 21:1028‐1034

“…To his credit, and in contrast to some recent literature, Jenicek stops short of attempting to expand the meaning of EBM per se to encompass the other disciplines at play in his vision. Jenicek's call is nonetheless salient to contemporary issues surrounding EBM.…”

“…That is, the question of epistemic commitment: a phrase we use here to indicate the underlying presuppositions about the nature of knowledge to which contributors to a discussion commit themselves by the claims they make. At a time when influential authors are calling for the ‘science’ of EBM to be ‘expanded’ and for its underlying knowledge base to be ‘supplemented’, it is crucial that we are clear on which assumptions about knowledge we are committed to if we accept certain claims. We therefore begin our conclusion by recapitulating our interpretation of EBM‐Cog.…”