A neo-pragmatist view of evidence-based medicine (EBM)

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Brian Walsh


 In contrast to previous papers in which Evidence Based Medicine (EBM) is faulted for not checking its conceptual structure against philosophy, this paper excuses EBM. Philosophy was based on essentialism, objectivity, and the Cartesian divide between the mind inside and the world outside. Knowledge was a representation of reality, inspected for accuracy by the retina, and polished from time to time.  Some post-Kantian philosophers have abandoned this set-up, regarding it as just one image, accompanied by pretensions to a superior understanding of truth, the mind and knowledge. EBM, in this paper, is forgiven for not trying to square off with this traditional image, rather noticing that people are suffering, seeking a method of coping with illness, and asking, “Does it work?”  This paper, drawing on the thought of Richard Rorty, views EBM as having capitalized on the development of such contingencies as statistics and the world wide web, and having provided another description of patients, in terms of “the evidence”, rather than focusing on discovering what patients are “really like”. In its search for knowledge, EBM has changed the definition of “objectivity” to agreement among qualified people. Even so, clinical research, although “useful”, does tend to hark back to ascertaining what really is the case, whatever that means. It is hard to see what EBM can do about this since most patients seek this kind of bio-medical knowledge when consulting a doctor (although some consult alternative health practitioners, who often use a different model).

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