The Limitations and Misuses of Evidence-Based Medicine: A Critical Evaluation
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Over the last 20 years, since the introduction and elaboration of the principles of evidence-based medicine (EBM) within the medical profession, we have seen its broad scale acceptance and rise to universal prominence. Educators, legislators, insurance providers, professional associations, healthcare practitioners of various modalities, lawyers, journalists and other commentators – all appear to be driven by a mania for ‘evidence’ in medicine. However, EBM is a deeply flawed system and under the pervasive influence of the pharmaceutical industry these flaws have become more entrenched rather than identified and corrected. Moreover, the motive of ‘medicine for profit’ has given rise to a situation that not only resists correction, but also tends to amplify and expand the scope of bad science and poor evidence in medicine. This paper does not argue against the idea that medical practice should be based on the best available evidence. The examination here pertains to the kinds of evidence that have become acceptable, and those which are now devalued, many of which are just as - if not more - relevant to a holistic clinical practice. The main tenet here is that, in terms of medical epistemology, the pendulum has swung too far in the direction of empiricism - an untenable position with respect to clinical knowledge - and that it is time for it to swing back to the sensible middle ground between quantitative and qualitative research. Additionally, it is crucial that we understand the multifarious ways in which this newly developing system may be perverted to serve other agendas. These considerations are all the more important for the complementary medicine profession, which appears to be in the process of wholeheartedly embracing the current paradigm of EBM, ‘warts and all’.
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