'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice

Area of Science:

• Philosophy of Medicine
• Evidence-Based Medicine (EBM) Critique
• Scientific Methodology

Background:

• Evidence-based medicine (EBM) posits a distinction between empirical evidence and intuition.
• The definition and evidentiary basis of EBM's hierarchy of evidence remain unclear.
• Concerns exist regarding the demonstrable superiority of EBM in clinical practice.

Purpose of the Study:

• To deconstruct the foundational claims of evidence-based medicine (EBM).
• To critically examine the concept of 'evidence' within the EBM paradigm.
• To expose the inherent limitations and potential self-contradictions within EBM.

Main Methods:

• Utilized deconstructive analysis, drawing on the philosophical work of Jacques Derrida.
• Focused on deconstructing the randomized controlled trial (RCT) as the cornerstone of EBM.
• Analyzed the logical underpinnings of EBM's distinction between admissible and inadmissible evidence.

Main Results:

• EBM's demarcation between 'evidence' and 'intuition' is not empirically supported.
• The core distinction within EBM lacks an evidentiary basis, relying instead on intuition.
• Randomized controlled trials (RCTs) do not provide incontrovertible evidence for EBM itself.

Conclusions:

• Evidence-based medicine (EBM) creates an illusion of scientific certainty.
• EBM's foundational principles are not self-evident and may rely on faith or ideology.
• Practitioners, policymakers, and patients should be aware of EBM's inherent limitations.