The EBM argument hygiene campaign

The campaign promoting evidence-based medicine (EBM) shares similarities with Joseph Lister's 19th century campaign promoting surgical antisepsis. Both target medical practitioners as their primary clients, and both appeal to these clients in the manner of a public health programme, arguing that their standards are authoritative and relevant, that the clients fail to meet them, and that this failure is a problem that requires the clients to change. Both promote hygienic solutions to the problems that they identify, the problem of microbial pathogens in the case of Lister, and the process of clinical decision making in the case of EBM. Hygienic solutions aim to operationalize standards as case-independent procedures that can be performed as habits, and seek to identify instruments of purification against sources of contamination. EBM's solution is hygienic because it characterizes clinical decision-making behaviour as a source of contamination and because it promotes a general procedure designed to correct it. Comparing the EBM campaign to Lister's helps to explain why some clinicians have had trouble trying to implement EBM as a decision-making procedure in particular cases. EBM promotes a hygienic solution, but unlike Lister, does not confront a well-defined, empirically grounded problem. Some of the difficulties with EBM stem from a mismatch between its hygienic solution and the complexity and case-dependency of clinical decision making.