Evidence, through the looking glass. Commentary on Devisch and Murray (2009) 'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice.

摘要

'When I use a word it means just what I choose it to mean - neither more nor less,' Humpty Dumpty retorts when Alice dares to question his use of a particular term. And so goes the response of proponents of evidence-based medicine (EBM) whenever the term 'evidence' is examined, for the definition of the term has become mutable, easily altered to strengthen a claim or avoid criticism, only to be shifted again to parry a new critique [1]. Perhaps the instability in the usage of the term 'evidence' represents an evolution of EBM rather than duplicity on the part of proponents [2], but regardless we must consider Alice's subsequent observation: The question is whether you can make words mean so many different things.