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Abstract
The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterise as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing. This paper lays out the claims of EBM—its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine—and analyses them in the framework of a sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicine, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and the sociology of medicine. The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.
