Evidence based on what?

At 21 years old, evidence-based medicine (EBM) is an established central pillar of modern healthcare.The model continues to intentionally develop its structure and meaning on an almost monthly basis (Guyatt et al. 2011).In-line with this, an untiring body of literature aims to analyse its strengths and limitations: often provocatively (Cartwright 2011, Seshia and Young 2013), sometimes sympathetically (Djulbegovic and Guyatt 2009, Cipriani 2013).Studies have also examined the quality of data being used in EBM, questioning its value and trustworthiness (Ioannidis 2005, Pereira and Ioannidis 2011, Kerry et al. 2013).Further, there have been moves to suggest alternative modes of practice, specifically person-centred medicine (Miles and Mezzich 2011, Miles and Asbridge 2013).Conceptually, the vast majority of the critique is focussed on either EBM's epistemology (what methods produce what evidence) or its mechanics (what's the best ways to implement it).After two decades of witnessing successes and limitations, it is now both possible and timely to consider the very foundations of EBM and how fit-for-purpose these are.Such an inquiry will promote and facilitate future development of the model, especially regarding translating population data to individual cases, and the relationship between epidemiological and mechanistic data -both central and stubborn concerns of EBM critics (Muckart 2013, Clarke et al. 2012).