A Postmodern View of Evidence-based Medicine (EBM)

Abstract

Some readers of EBM believe they are ascertaining what really is the case. This is modern thinking, reflecting the enlightenment. This paper presents a postmodern approach: EBM is depicted as image. Some categories have collapsed into each other: there is no longer a clear dividing line between what suits the doctor and what suits the patient, or between EBM and medicine commercialization and capitalism, which gets little mention in a research paper. The postmodern self of the experimental subject or the patient is not depicted as stable, integrated and rational. This has implications, particularly for psychological medicine and for training of doctors. The complex results of complex studies are amalgamated through meta-analyses, and their presentation in multiply-edited papers in high-impact international journals enhances the image of EBM and verges into rhetoric. Even so, these ideas have been challenged: postmodern theorists have given up too soon on such struggles as justice. The eschewing of universal principles easily drifts into “anything goes”.