David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Perspectives in Biology and Medicine 52 (2):168-187 (2009)
Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the culprit of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal.
|Keywords||Evidence Evidence-based medicine philosophy of medicine medical epistemology|
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Citations of this work BETA
Jonathan Fuller (2013). Rhetoric and Argumentation: How Clinical Practice Guidelines Think. Journal of Evaluation in Clinical Practice 19 (3):433-441.
Jacob Stegenga (2014). Down with the Hierarchies. Topoi 33 (2):313-322.
Maya J. Goldenberg (2010). From Popperian Science to Normal Science. Commentary on Sestini (2009) 'Epistemology and Ethics of Evidence‐Based Medicine'. Journal of Evaluation in Clinical Practice 16 (2):306-309.
Leah M. McClimans & John Browne (2011). Choosing a Patient-Reported Outcome Measure. Theoretical Medicine and Bioethics 32 (1):47-60.
Mark R. Tonelli (2011). Not a Philosophy of Clinical Medicine: A Commentary on 'The Philosophy of Evidence‐Based Medicine' Howick, J. Ed. (2001). Journal of Evaluation in Clinical Practice 17 (5):1013-1017.
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