Perspectives in Biology and Medicine 52 (2):168-187 (2009)

Authors
Maya J. Goldenberg
University of Guelph
Abstract
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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DOI 10.1353/pbm.0.0080
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Down with the Hierarchies.Jacob Stegenga - 2014 - Topoi 33 (2):313-322.
Rhetoric and Argumentation: How Clinical Practice Guidelines Think.Jonathan Fuller - 2013 - Journal of Evaluation in Clinical Practice 19 (3):433-441.
The Need for a Rationalist Turn in Evidence-Based Medicine.Michael P. Kelly - 2018 - Journal of Evaluation in Clinical Practice 24 (5):1158-1165.

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