ABSTRACT
The belief that medical practice ought in some way to be based on ‘evidence’ is by no means new. However, widespread acceptance of the explicit doctrine that daily clinical practice should be based on sound and systematically assembled research evidence about the effectiveness of each therapeutic procedure (‘intervention’ hereafter) employed has grown only over the last forty years and has been a formal component of UK health policy only since the early 1990s. The principle has been extended to other clinical professions, including nursing, midwifery, dentistry and physiotherapy, so that more generic expressions such as ‘evidence-based practice’ and ‘evidence-based health care’ are now current. Similar reasoning has also been employed in sectors other than health, especially in education, criminal justice and social work (Davies et al. 2000). Evidence-based medicine (EBM) and its derivatives is usually presented by its proponents in the language of science, and there is clearly some justification for this; currently dominant ideas are certainly based on the notion of applying scientific research findings to clinical practice. But EBM is also a political phenomenon, in at least two senses. First, there is more than one conception of what constitutes EBM, so that contemporary orthodoxy represents the dominance of one set of ideas, and their exponents, over another. Second, this orthodoxy has become a core element of UK public policy.
