Legitimacy, Authority, and Hierarchy: Critical Challenges for Evidence-Based Medicine

This paper examines four challenges that proponents of evidence-based medicine (EBM) must address to establish its claims to universality and legitimacy. It is argued that the failures to meet the evidence-of-effectiveness challenge, the authority challenge, the conflicting hierarchy challenge, and the definition-of-evidence challenge diminish arguments for the superiority of EBM. In the second part of the essay, recent developments in the theory of EBM are discussed with specific reference to what is termed the Oslerian turn, and a relationship between EBM and rationality is entertained. [Brief Treatment and Crisis Intervention 4:197‐204 (2004)]