Where is Sancho? A commentary on Murray et al. (2007) ‘No exit? Intellectual integrity under the regime of “evidence” and “best‐practices” ’

Medicine and evidence: knowledge and action in clinical practice

“…We now move to the next major article in the current Thematic Edition [30] and its associated commissioned commentaries [31–34]. Like Tonelli’s article, the piece by Murray and his colleagues [30] has been synthesized in response to major commentary on an earlier publication [35].…”

“…In the second commentary which follows, Couto [32], while agreeing that EBM has long been denounced as a ‘set of crooked theories and principles’, is unable to agree with Murray et al . [30] that a decline in healthcare innovation can be ascribed to EBM – yet .…”

“…In the pages to follow we therefore present a sustained examination and discussion of alternative positions in medical epistemology [24,41,48] and the philosophy of medicine [30–35] that question the fundamental assumptions of EBM, as well as discussions of critical thinking and its relationship both to EBM and to good practice in general [45,46]. The debate must continue.…”

Towards an ethics of authentic practice

“…Medicine is often about questions of life and death, and medicine figures into patients' understanding of a meaningful life, a life worth living. If medical practitioners really think these questions can be dismissed as ‘esoteric’ or ‘postmodern rubbish’, then this would, we believe, count as evidence for the decline of actual health care (to be distinguished from technical knowledge ) that Couto contests [4].…”

“…With him, we hope that the issues raised in these pages will be reflected upon by others in the community and beyond. We are no less grateful to our generous respondents and critics [3][4][5][6]. In this paper, we take pains to respond to them.…”