Georg Ivanovas From Autism to Humanism - systems theory in medicine

2. The medical paradigm

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2.5 The limits of evidence based medicine (EBM)

The last decade was characterised by a growing importance of the so called ‘evidence based medicine’ (EBM). This is a medicine strictly based on controlled trails, neglecting personal impression or experience, or even other types of understanding the patient. The main question today seems to be how practitioners and patients can be convinced to follow the results of the 10,000 new randomised trials included in MEDLINE every year. “From best evidence to best practice” (Grol/Grimshaw 2003) is such a slogan. A situation is intended where a physician should be, at best, “remote-controlled by epidemiologists, statisticians, state and health insurances” (Kienle et al 2003, my translation).

But there is increasing criticism with regard to this concept, mostly moderate, sometimes drastic like in the New Scientist:You’d be a fool to believe everything in the papers. Made-up facts, half-baked analysis, hand-picked conclusions - yes, scientific papers can seem no more reliable than the tabloid press” (Matthew 2003).

This chapter will demonstrate that the epistemological problem of medicine is found in evidence based medicine as well, thus restricting its validity.


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