The Real World Failure of Evidence-Based Medicine

The International Journal of Person Centered Medicine, Volume 1, Issue 2, pp. 295-300, 2011

6 Pages Posted: 28 Dec 2017

See all articles by C G Miller

C G Miller

Clifford Miller

Professor Donald Miller

University of Washington - School of Medicine

Date Written: June 9, 2011

Abstract

As a way to make medical decisions, Evidence-Based Medicine (EBM) has failed. EBM's failure arises from not being founded on real-world decision-making. EBM aspires to a scientific standard for the best way to treat a disease and determine its cause, but it fails to recognise that the scientific method is inapplicable to medical and other real-world decision-making. EBM also wrongly assumes that evidence can be marshaled and applied according to an hierarchy that is determined in an argument by authority to the method by which it has been obtained. If EBM had valid theoretical, practical or empirical foundations, there would be no hierarchy of evidence. In all real-world decision-making, evidence stands or falls on its inherent reliability. This has to be and can only be assessed on a case-by-case basis applying understanding and wisdom against the background of all available facts — the “factual matrix.” EBM's failure is structural and was inevitable from its inception. EBM confuses the inherent reliability and probative value of evidence with the means by which it is obtained.

EBM is therefore an ad hoc construct and is not a valid basis for medical decision-making. This is further demonstrated by its exclusion of relevant scientific and probative real-world decision-making evidence and processes. It draws upon a narrow evidence base that is itself inherently unreliable. It fails to take adequate account of the nature of causation, the full range of evidence relevant to its determination, and differing approaches to determining cause and effect in real-world decision-making. EBM also makes a muddled attempt to emulate the scientific method and it does not acknowledge the role of experience, understanding and wisdom in making medical decisions.

Keywords: Anecdote, Causation, Evidence-Based Medicine, Hierarchy of Evidence, Individual Patients Law, Medical Decision-Making, Randomised Controlled Trials, Science, Scientific Theory

Suggested Citation

Miller, C G and Miller, Donald, The Real World Failure of Evidence-Based Medicine (June 9, 2011). The International Journal of Person Centered Medicine, Volume 1, Issue 2, pp. 295-300, 2011. Available at SSRN: https://ssrn.com/abstract=3092627

C G Miller (Contact Author)

Clifford Miller ( email )

26 Elmfield Road
9th Floor, South Tower
Bromley, Kent BR1 1WA
United Kingdom

Donald Miller

University of Washington - School of Medicine

Box 356340
1925 N.E. Pacific Street
Seattle, WA 98195-6340
United States

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