ABSTRACT

This chapter examines the views of evidence-based medicine (EBM). The author's account of EBM is based on Jeremy Howick's excellent book on the subject. According to Howick, the proponents of EBM arrange evidence for medical claims in a hierarchy. The author argues in favour of the Russo–Williamson thesis, and against the EBM position by giving a case in which exclusive reliance on randomized controlled trials (RCTs) and neglect of evidence of mechanism would have led researchers to the wrong conclusion regarding the efficacy of a proposed medicine. The case is a famous one. It concerns the three trials of streptomycin and other anti-tuberculosis chemical agents, which were carried out by the British Medical Research Council (MRC) in the period 1947–51. Jorgen Lehmann had got the idea of looking for Para-amino-salicylic acid (PAS) when his friend Bernheim told him in 1940 the result of an experiment in which adding aspirin to a culture of tuberculous bacilli increased their consumption of oxygen.