Evidence-Based Medicine and General Practice

There have been relatively few critical evaluations of evidence-based medicine (EBM).¹ This is partly because of the novelty of the enterprise: it is only since the early 1990s that the term has had general currency, although the closely related outcomes based research has had a longer history in the United States.² However, another reason for the lack of critical gaze is that EBM appears to rest on an innocuous truism, a point amusingly made by a modern Socrates questioning Enthusiasticus, a supporter of EBM. ‘I thought that all doctors were trained in the scientific tradition, one tenet of which is to examine the evidence on which their practice is based. How then does this new evidence-based medicine differ from traditional medicine?’ (Grahame-Smith, 1995:1126). EBM does not differ from traditional medicine because it insists that medical practice should be based on evidence, rather EBM takes a different definition of what is good medical evidence and what are appropriate mechanisms for finding and evaluating this evidence.