A view of Evidence-based Medicine from Karl Popper.

Abstract

Background: Popper has argued that knowledge is insecure, and moved the emphasis to conjecture and refutation. Science, Popper avers, does not build up universal laws from singular statements (representing events), since the principle of induction is non-existent. He would see many instances of confirmation of EBM methods, but EBM theory is too vague for refutation. Methods: I consider whether EBM has a theory, or whether it is heuristic, a method. I examine EBM's use of inductivism and falsificationism. I look at Popper's approach to knowledge (conjecture and refutation) and I relate this to EBM. Results: Popper writes about how to evaluate whether theories are scientific. But this scarcely applies to EBM. This is because EBM has left theory to the academics while it proceeds to develop and promulgate a method of practising medicine. Contra Popper, EBM does not put forward a theory for scholarly debate or empirical testing. By contrast, it promulgates a strict, detailed method whose merits are self-evident. (Who will argue against the evidence?) Conclusions: While EBM makes extensive use of falsification in evaluating tests and treatments, as a whole it fails to reach scientific status, as judged by Popper. It scarcely puts forward a risky theory to be challenged, and such theory as can be spider-webbed together is too diffuse to be precisely defined then falsified. Even so, I have provided a guide towards evaluating such EBM theory as there is.