In this issue of Journal of Evaluation in Clinical Practice, Tonelli criticizes the ‘philosophy’ of the evidence‐based medicine (EBM) movement and advocates a ‘case‐based’ or ‘casuistic’ alternative to EBM – I shall call this case‐based medicine, CBM. -/- Here, I summarize Tonelli’s article, comment on it critically, and then proceed to advocate commitment to knowledge‐based medicine instead. More specifically, I advocate commitment to scientific medicine and to its precursor, quasi‐scientific medicine – to efforts to bring these about as expeditiously as (...) possible. (shrink)

Clinical research must be understood to be the foundation of scientific medicine of the clinical type. But the essence of scientific clinical medicine remains a matter of profound confusion, even in clinical academia, and so does the essence of clinical research. The confusion now revolves, principally, around ‘clinical epidemiology’. We address clinical research in the meaning of quintessentially ‘applied’ clinical research, which we take to be the foundation of the scientific knowledge base of clinical medicine, of gnosis (dia‐, etio‐, pro‐) (...) in it. More specifically, we address the essence, priorities, and status quo of this research – and argue that the requisite theory of this is not a matter of ‘clinical epidemiology’ but of theory of clinical research endogenous to clinical (rather than epidemiological) academia. (shrink)