Science-Based Medicine

Not the same as Evidence Based Medicine? The problem with EBM is, rather, that it ranks basic science principles as being on either very lowest rung or the second lowest rung on the various hierarchies of evidence that EBM promulgates as the way to evaluate the reliability of scientific evidence to be used in deciding which therapies work. The most well-known of these is the that published by the Centre for Evidence-Based Medicine, but there are others. Eddie Lang, for instance, places basic research second from the bottom, just above anecdotal clinical experience of the sort favored by Dr. Jay Gordon (see Figure 2). Duke University doesn’t even really mention basic science; rather it appears to lump it together at the very bottom of the evidence pyramid under “background information.” When I first started to appreciate the difference between EBM and SBM, I basically had to be dragged, kicking and screaming, by Steve and Kimball, to look at these charts and realize that, yes, in the formal hierarchies of evidence used by the major centers for EBM, basic science and plausible scientific mechanisms do rank at or near the bottom. I didn’t want to accept that it was true. I really didn’t. I didn’t want to believe that SBM is not synonymous with EBM, which would be as it should be in an ideal world.

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