What philosophy does EBM need?


Check your health!
We want to hear your experiences of EBM…

Thanks to David Norris for his comment (@davidcnorrismd) as I had indeed missed his review of the recent book Ending Medical Reversal by Vinayak Prasad and Adam Cifu. I now look forward to part 2 of his post as I’m curious to learn about his ideas in part 1 to “move clinical science beyond the Stone Age”.

Meanwhile, I take the opportunity to say a few words about philosophy, in particular about the kind of philosophy that I (and my colleagues at EBM+) believe might help the health sciences at large. These reflections are prompted by Norris’ criticism of the use of Kuhn by the book’s authors, and more generally by the philosophical tools applied therein.


One point concerns how to understand EBM within the whole development of the medical sciences. Here, there is no easy historical argument to make, as also suggested by Timo Bolt in his book, A Doctor’s Orders. We must simultaneously investigate the macro- and the micro-history of medicine, in order to understand why and how EBM came into existence in the first place, and why it attracted so much consensus as well as criticism.


It is hoped that these historical reconstructions will also benefit from rigorous and attentive philosophical analyses of key concepts such as evidence, mechanism, or causality. In part, this is the objective of EBM+ in developing tools for ‘medical methodology’ and articulating precisely how current clinical methods are suboptimal.


Succeeding in writing balanced, informative, and constructive macro- and micro-histories of EBM – which are also philosophically informed and oriented –  is not independent from integration with other forms of investigations. What I have in mind here is a blend of HPS approaches and PSP. This second component, in particular, allows us to integrate some sociological considerations about EBM.


In other words, behind the movement and the iconic hierarchy of evidence, there are scientists, doctors, health officers – i.e. people – whose stories and experiences of EBM are greatly important to a fruitful, healthy, and applicable HPS for EBM.


At EBM+ we are most interested in hearing about their stories. If you are one of those people, please come talk to us.


Words by Federica Russo



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