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Evidence‐based medicine: a Kuhnian perspective of a transvestite non‐theory
Author(s) -
MD Joaquim S. Couto
Publication year - 1998
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.1998.tb00085.x
Subject(s) - evidence based medicine , epistemology , context (archaeology) , rhetoric , perspective (graphical) , alternative medicine , irrational number , randomized controlled trial , authoritarianism , scientific evidence , medline , psychology , medicine , philosophy , law , political science , history , computer science , politics , linguistics , geometry , mathematics , archaeology , surgery , pathology , artificial intelligence , democracy
Evidence‐based medicine (EBM) has been presented by its protagonists as a new paradigm for medical practice. In this article that claim is analysed through the theory of scientific development proposed by Thomas S. Kuhn in 1962. Traditional medical paradigms are discussed, as well as the assumptions of the supposedly ‘new’ paradigm of EBM. The value of the results of randomized clinical trials (RCTs) for the elaboration of clinical guidelines is analysed within the context of the assumptions of EBM and the paradigm concept of Thomas S. Kuhn. It is argued that the results of RCTs, whenever contradicted by fundamental medical theory, constitute inadmissible evidence for the development of clinical guidelines. The supremacy of results of clinical trials over traditional medical paradigms, advocated by the protagonists of EBM, is rejected. Fundamental contradictions of EBM are also exposed: the fact that there is no evidence to support the utility of EBM and its call for a new type of authoritarianism in medicine. Finally, it is suggested that ‘epidemiology‐based medical practice’ is a better, rhetoric‐free designation for what is currently termed evidence‐based medicine*. It is concluded that EBM is not what it claims to be and that its assumptions are simply irrational.