Please don't be fooled by the branding. Evidence-Based Medicine[1] is a particular movement that makes particular claims about what sorts of evidence are bette

Please don't be fooled by the branding. Evidence-Based Medicine[1] is a particular movement that makes particular claims about what sorts of evidence are better than other sorts of evidence, and how we should (re-)structure clinical practice to revolve around these. In other words, EBC != evidence-based medicine. It strongly emphasizes large-scale studies at the expense of other types of empirical knowledge, namely the direct clinical experience of the practitioners. What might be the harm in doing so? Why shouldn't we all rely only on large-scale meta-analyses to guide treatment? 1. There are important clinical questions that are difficult to measure in a double-blind clinical framework; the risk is that we end up optimizing what we can easily measure over what is truly important, the health of the patient. 2. It increasingly risks turning doctors into assembly-line technicians that are only there to take the indicated 'evidence-based' tests and treatments. It takes agency and decisionmaking effectively from the hands of doctors and transfers it to large research bureaucracies, which may or may not be asking the right questions. It increases the social and informational distance between the patient and the point of decision-making -- which we've seen can have disastrous consequences (for example, in planned economies), when that distance impeded the smooth flow of information. 3. It presupposes the the studies and meta-analyses in the research pipeline are a good decomposition of the current state of medical knowledge. E.g. if there's an analysis that says 'treat a person with diabetes with treatment X', then that approach would work well, regardless of the specifics of the actual patient at the clinical level. Patients don't come cleanly with a single diagnositic label; most people with chronic conditions have more than one, for example. Note that the methodology and effectiveness of Evidence-Based Medicine has itself not been subjected to rigorous large-scale scientific evaluation; we are literally being asked to take on faith that this particular 'EBC' implementation of evidence-based medicine will be better. [1] https://en.wikipedia.org/wiki/Evidence-based_medicine#Limitations_and_criticism https://en.wikipedia.org/wiki/Evidence-based_medicine#Limita...