EBM has few features of a scientific endeavour. It does not involve generating or testing hypotheses although the research which its proponents seek to influence does. It authoritatively advocates very specific processes for conducting and interpreting research, embodied in its hierarchy of research design.
The reason this movement has gained prominence and authority within and beyond medicine since 1992 is the support it naturally receives from bureaucracies involved in the delivery of health care. It provides definitive and comprehensible information free from expert obfuscation and fence-sitting, and a means by which a bureaucracy can use medical research to support desired policy and decisions. This is true of US pharmaceutical corporations which are able to drive favourable execution and analysis of studies in support of the benefit of drugs they have developed while maintaining a mantle of scientific authority as derived from EBM methods. It is also true of government bureaucracies in Australia, Britain and other countries where cost containment and the appearance of diligent health care delivery are high priorities.
It is appropriate that these bureaucracies adopt convenient and powerful means to achieve their ends; it is not their responsibility to decide whether EBM actually improves the standard of medical research or practice.
It should also be noted that most medical research which is currently conducted and disseminated with an EBM imprimatur remains high quality science of high value to patients; the pedigrees of the inner workings of these projects are the established disciplines of statistics, epidemiology and what was once simply called scientific research. EBM as a brand carries intellectual authority beyond the value of its constituent techniques. There is no reason for the term "evidence-based medicine" to be used nor for the movement to describe itself with these words. All the underlying philosophy and methods were adopted and promoted before the movement began and all would continue if "EBM" ceased to exist. Medicine is not medicine if it is not evidence-based.
The socially authoritative nature of the movement has tangible negative effects on day-to-day medical practice and education. Clinicians are offered the quick and easy charms of pre-digested and generalised yet respectable recipes for diagnosis and management which are less beneficial to individual patients than the historically established hypothetico-deductive and skeptical approach to clinical reasoning. Research design is distorted by EBM imperatives regardless of their relevance to the question at hand. Medical schools are vulnerable to the appeal of a framework which is more easily summed up and inserted into curricula than the unglamorous and bothersome grind of experiential learning through direct patient contact.
The socially authoritative nature of the movement has tangible negative effects on day-to-day medical practice and education. Clinicians are offered the quick and easy charms of pre-digested and generalised yet respectable recipes for diagnosis and management which are less beneficial to individual patients than the historically established hypothetico-deductive and skeptical approach to clinical reasoning. Research design is distorted by EBM imperatives regardless of their relevance to the question at hand. Medical schools are vulnerable to the appeal of a framework which is more easily summed up and inserted into curricula than the unglamorous and bothersome grind of experiential learning through direct patient contact.
EBM sounds annoying. I guess it's like a bunch of other movements to standardise professional practice into a box-ticking exercise. I can see the appeal for people who have no reasoning skills.
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