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Evidence, discovery and justification: the case of evidence‐based medicine
Author(s) -
Gaeta Rodolfo,
Gentile Nelida
Publication year - 2016
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/jep.12419
Subject(s) - epistemology , scope (computer science) , evidence based medicine , empirical evidence , paradigm shift , philosophy of medicine , field (mathematics) , best evidence , scientific evidence , virtue , engineering ethics , psychology , medline , medicine , alternative medicine , philosophy , computer science , political science , law , medical education , mathematics , pathology , pure mathematics , programming language , engineering
The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence‐based medicine ( EBM ), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM , we evaluate the status of EBM and suggest that EBM is mainly a meta‐methodology. Then, we outline an evaluation of the thesis that EBM is a ‘new paradigm’ in the practice of medicine. We argue that EBM does not seem to have arisen in the way K uhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by K uhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what K uhn once called a ‘paradigm’ and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine.