ABSTRACT
This chapter reflects on the shortcomings in the philosophy of evidence-based medicine (EBM). It features three areas: resource allocation, politics and management. The concerns about EBM are derived from the work of the Frankfurt school, who responded to the rise of rationalism in the mid-part of the twentieth century. The problems posed by resource allocation and EBM are in many ways exacerbated by the political problems faced by health care. Health has always been a political issue. The role of health care management in the 1990s is to support the allocation of resources along evidence-based lines and in line with the political ideology of selectivity; that is, those who need the care should benefit most. In response to the concerns about managed care, some effort is now being concentrated into involving the public in the management of medicine, particularly in the area of priority setting.
