Open Access Open Access  Restricted Access Subscription or Fee Access

Is Evidence-based Medicine positivist?

Brian Walsh, Grant Gillett


Aim: This paper aims to examine whether Evidence-based Medicine (EBM) is positivist and to consider the implications of the answer.

Method The initial announcement of EBM in 1992 is used to ascertainthe philosophy of EBM.  The definition of  positivism is taken from Ian Hacking. The paper draws on Greavesfor a discussion of whether medicine can be concentrated into a positivistic model. Particular attention is given to a landmark paper on EBM philosophy published in 2009.

Results: The defence against the charge of positivism is noted.  Even so, it is concluded that EBM is positivist.  It emphasises observation, verification and method over theory.  Yet allopathy distinguishes itself from complementary and alternative approaches to healing by holding to scientific theory.

Conclusion: EBM is positivist.  In consequence, EBM is too limited to be synonymous with or quivalent to good medicine or singulary to inform an effective health care, which involves many dimensions, including interpersonal/social and philosophical dimensions.  EBM gives no account of symbolism in medicine.  Complaining about lack of attention to the evidence, it scarcely adjusts the ideal medical model to what doctors actually use, where there is less certainty and control over variables.

Full Text:



The Evidence-Based Medicine Working Group. (1992) Evidence-based medicine: a new approach to teaching the practice of medicine. Journal of the American Medical Association. 268(17), 2420-2425.

Gillett, G.R. (2004). Bioethics in the clinic: Hippocratic reflections. Baltimore and London: The Johns Hopkins University Press.

Djulbegovic, B., Guyatt, G.H. and Ashcroft, A.E. (2009). Epistemologic inquiries in evidence-based medicine. Cancer Control 16(2),158-168.

Hacking, I. (1983). Representing and intervening: Introductory topics in the philosophy of natural science. Cambridge: Cambridge University Press.

Greaves, D. (1996). Mystery in Western medicine. Aldershot, England: Avebury.

Silva, S.A. and Wyer, P.C. (2009). Where is the wisdom? II – evidence-based medicine and the epistemological crisis in clinical medicine. Exposition and commentary on Djulbegovic, B., Guyatt, G. H. and Ashcroft, R. E. (2009) Cancer Control 16, 158–168. Journal of Evaluation in Clinical Practice 15(6),899-906.

Loughlin, M. (2003). Ethics and evidence-based medicine: fallibility and responsibility in clinical science. (Kenneth Goodman, Cambridge University Press, Cambridge). Journal of Evaluation in Clinical Practice 9(2),141-144.

Goldenberg, M.J. (2006). On evidence and evidence-based medicine: lessons from the philosophy of science. Social Science and Medicine 62,2621-2632.

Miles, A., Grey, J., Polychronis, A., Price, N. and Melchiorri, C. (2004). Developments in the evidence-based health care debate-2004. Journal of Evaluation in Clinical Practice 10(2),129-142.

Gillett, G.R. (2004). Clinical medicine and the quest for certainty. Social Science and Medicine 58,727-738.

Loughlin, M. (2008). Reason, reality and objectivity—shared dogmas and distortions in the way in which both “scientistic” and “postmodern” commentators frame the EBM debate. Journal of Evaluation in Clinical Practice 14(5),665-671.

Miles, A., Loughlin, M. and Polychronis, A. (2007). Medicine and evidence: knowledge and action in clinical practice. Journal of Evaluation in Clinical Practice 13(4),481-503.

Kant, I. (1789). The critique of pure reason (N. Kemp Smith, trans.). London: Macmillan. (1929).

Deleuze, G., Guattari, F. (1987). A thousand plateaus: Capitalism and schizophrenia (B. Massumi, trans). Minneapolis and London: University of Minnesota Press.

Miles, A. (2009). On a Medicine of the Whole Person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. Journal of Evalution in Clinical Practice 15, 941-949



  • There are currently no refbacks.