Evidence-based medicine

Evidence-based medicine or EBM was introduced in the early 1990s as a move to increase medicine’s uptake of published scientific evidence, especially evidence from clinical epidemiology. It is now the standard, such that its underlying philosophical ideas have become invisible to many. However, since its launch, evidence-based medicine has had its critics, including healthcare professionals and philosophers. Philosophers began to ask questions: what is ‘evidence’ according to evidence-based medicine? What justifies EBM’s confidence in some forms of evidence – namely, randomized trials and meta-analyses – over others like observational studies or evidence of biologic mechanisms? Evidence-based medicine led to a renaissance in philosophical attention towards medicine and medical evidence. In today’s consultation, I speak with four philosophers of medicine: Ross Upshur, Jeremy Howick, Jacob Stegenga and John Worrall. Here’s my conversation with Ross Upshur, Professor in the Dalla Lana School of Public Heath at the University of Toronto.