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Mat Mercuri: Examining the Epistemic Culture of Clinical Medicine: Challenges to the Evidence Based Medicine Framework
September 13 @ 12:00 pm - 1:00 pm
Abstract: Evidence based medicine (EBM), the dominant framework of clinical practice, has been described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996; p.71). The rise of the EBM movement has been accompanied by the development of “rules” for what constitutes evidence – i.e. the so-called “hierarchy of evidence”. While undoubtedly useful as a heuristic device for critical appraisal of research studies in the context of clinical practice, such rules have come under scrutiny from both scientists and philosophers. Notable criticisms relate to the privileged status given to clinical trials, and the disregard for the evidential value of mechanisms. Such criticisms lead to the suggestion of a logically incoherent evidence framework at the core of the EBM movement. This presentation will provide an overview of what it is that clinical medicine seeks evidence about, articulate the EBM approach to generating and appraising evidence, and examine the criticisms of the EBM evidence hierarchy. Historical examples demonstrating the inadequacy of the EBM perspective on evidence will also be presented.