Evidence Based Medicine in Cultural and Historical Context

*To whom correspondence should be addressed: Julian Z. Xue McGill University, Department of Biology, Montreal, Canada, H3A 1B1 Email: [email protected] This is progress in all senses: they managed to reduce an immense cognitive dissonance within our society, a dissonance that leads laypeople to scratch their heads and ask: “...and what were they doing before that?” Since then, EBM has spread with immense speed, but also have had its fair share of criticsvii. Many explanations are given for this conflict, from a “sociology of professions”viii to lingering suspicions of laziness and closed-mindedness (by both sides), but one itch was never scratched: perhaps EBM is not culturally neutral. Perhaps it is a product of our Age of Reasonix, one of its crowning jewels, and its strengths and weaknesses are reflective of our society as a whole. Our culture uniquely worships efficiency and certainty under the umbrella of rationality. In the classic narrative, we have come to this through a triumph of science as well as struggles for a more reasonable society against a whimful aristocracyx. That almost all the evidence in EBM is used to further these goals cannot be called a coincidence; this is the deliberate (if often blind) action of a willful society. Evidence does not form its own goals! Indeed, evidence funded ill aims It is difficult to argue with the fundamental tenet of Evidence Based Medicine (EBM), the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patientsi. What sane, ethical person or culture can deny something so obvious? As members of a dominating society, however, we forget how current practices derived from the past and we mistake the present to be the only possibilityii. Looked across time, EBM is the perfectly unique product of the West, embedded as we are in rationalityiii, and our particular brand of EBM, steeped in rational methodology: RCT, meta-analyses, guidelines and quantificationiv, is far less universal than we might believe. Cries for EBM can be found as early as the late 18th century, but its modern carnation began in the 70’s with figures such as Dr. Arthur Cochrane and John Wennbergv. They denounced medicine as practiced then, based upon expert consensus and mental models which did not bear upon realityvi. Existing evidence must be organized and used, they reasoned, and the need for new and better evidence also became apparent. Evidence Based Medicine in Cultural and