Georg Ivanovas From Autism to Humanism - systems theory in medicine

2.5 The limits of evidence based medicine

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b) evaluation and validity

The question of accuracy and validity is a mostly settled issue (e.g., Sackett/Haynes 2002, Bland/Altman 2002, Irwing et al 2002). EBM is investigated philosophically (Sehon/Stanley 2003) and has its own journals (Evidence-based Medicine, Evidence-Based Mental Health, Evidence-Based Nursing). But all discussion is done in the framework of the given paradigm (chap. 3.10), of decidable questions (chap. 3.4). The gaps of uncertainty inherent in every scientific approach just don’t appear.

This is why proponents of EBM are convinced to provide the best evidence available and that “physicians who violate its precepts should ultimately face license suspension” (Muney cited in Sehon/Stanley 2003). But such explicit opinions do not alter the fact that EBM is characterized by immense epistemological inconsistencies.

First of all, the evaluation of a diagnostic processes is often not accurate (Knottnerus el al 2002). The more complex the diagnosed behaviour is (hyperuricaemia versus depression) the less valid the descriptions. For ‘grief’(classified according to DSM-IV or ICD-10) exist a lot of different models, though no valid or operationable statements are possible (Kersting et al 2003). Validity arises only if studies concentrate on a few parameters. But this is accompanied by a loss of validity for the observed behaviour. It cannot be other when complexity is investigated with a two-valued logic. That is, a therapy might be well established. The question is only for what and whom?

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