The Nature of Evidence in Evidence-Based Medicine

The evidence-based medicine (EBM) approach emerged during the 1970s and 1980s; with the aim of improving clinical practice and raising its efficiency by informing evidence-based medical research methodologies, especially the methodology of randomized controlled trials (RCTs) and their meta-analyses. EBM has become the subject of much debate in and out of medical care circles and in philosophy of science over EBM's short life as a result of the various claims made by its proponents about the rigorous criteria used to evaluate evidence regarding the efficacy of curative medical interventions. Through a comparative critical analysis, this study presents description of what EBM is, followed by an examination of the nature of the evidence within it and its epistemological and methodological justifications toward its categorical hierarchies of methodologies of evidence that placing RCTs on top and observational studies, mechanistic reasoning, and expert judgments below. The study emphasizes that a high quality evidential synthesis should replace strict hierarchies.