ArticleHealth research policy and systems2015
Evidence-based medicine: is it a bridge too far?
Article in Health research policy and systems, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Health risk behaviours, mental health and HbA1c: an overview of reviews of observational studies.BMJ open · 2025Pooled it
- Integrating patient values and preferences in healthcare: a systematic review of qualitative evidence.BMJ open · 2022Pooled it
- Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care.Journal of general internal medicine · 2018Pooled it
- Why family medicine requires a paradigm shift from linear guidelines to complexity science.Family medicine and community health · 2026Article
- General practitioners and management control through guidelines: a qualitative study of its effects on their practice.BMC primary care · 2026Article
- Expert recommendations for setting and adjusting airway pressure release ventilation based on clinical experience and basic science evidence.Frontiers in medicine · 2026Article
- In Defense of Metaphysics: A Kantian Approach to the Philosophy of Chiropractic.Journal of chiropractic humanities · 2025Review
- Proof of concept studies in mental health systems research: strategy and steps.International journal of mental health systems · 2025Review
- Setting the foundation for a national collaborative learning health system in acute TBI rehabilitation: CARE4TBI Year 1 experience.Learning health systems · 2025Article
- Modelling the impact on a local mental health system of previously implemented care programs: the experience of assertive outreach teams in Bizkaia (Spain).Epidemiology and psychiatric sciences · 2025Article
- The Difficulty Implementing Evidence-Based Practice in the Perioperative Setting.Anesthesia and analgesia · 2024Article
- Women's experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology.African journal of primary health care & family medicine · 2024Article
- Learning health systems and evidence ecosystems: a perspective on the future of evidence-based medicine and evidence-based guideline development.Health research policy and systems · 2024Article
- Article
- The effect of capacity building evidence-based medicine training on its implementation among healthcare professionals in Southwest Ethiopia: a controlled quasi-experimental outcome evaluation.BMC medical informatics and decision making · 2023Article
- External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series.Children (Basel, Switzerland) · 2023Article
- A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools-What Works, for Whom, and under What Circumstances?International journal of environmental research and public health · 2023Article
- Qualitative approach to better understand the trajectory of patients with early and moderate stage CKD.Clinical kidney journal · 2022Article
- Stochastic integrated model-based protocol for volume-controlled ventilation setting.Biomedical engineering online · 2022Article
- Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients.Annals of biomedical engineering · 2021Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThis paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science.
resultsThe need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context.
conclusionEBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.