Paper
Thursday, 20 July 2006
This presentation is part of : Evidence-Based Nursing and Public Policy: Issues Identified
Evidence-Based Medicine: How Much Clothes Does the Emperor Wear?
Mieke Grypdonck, PhD, Division of Nursing Science, Utrecht University, The Netherlands and Ghent University, Belgium, 3508 AB Utrecht, Netherlands and Tom Defloor, Nursing Science, Ghent University, Gent, Belgium.
Learning Objective #1: Understand a more critical view on use of EBP and an be aware of the issues related to EBP.
Learning Objective #2: Apply EBP more in accordance with its true characteristics.
Evidence Based Practiced (EBP) is well established, at least as an idea and as a norm. Scientist and practitioners alike continuously refer to the need to use EBP. There is, however, no evidence that EBP leads to better health care. In this paper, we will discuss serious shortcomings of the EBP-ideology, based on a philosophical analysis, experience with systematic reviews and published reviews and articles about EBP. According to Sackett, Evidence Based Medicine is for the believers. Thus EBP should be characterized as an ideology violating its own ideology. It is, moreover, based on an outdated notion of objectivity, introducing the risk for systematic bias. It is at the same time highly constructivist in nature and claiming dominance or exclusivity of its view and methods. Using the rules EBP proposes to judge the value of treatments and giving precedence to those that have been proven effective over those that have not, leads to the exclusion of valuable treatments, and therefore, it is very well possible that EBP has a negative influence on (aspects of) the health of the nation. Particularly the more vulnerable may suffer from the use of EBP. Suitable for the assessment of the effects of medications, the methods of EBP fail to lead to valuable conclusions when more complex issues such as (nursing) care issues are concerned. Whether EBP will disappear due to the defective nature of its principles is difficult to predict.

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