The philosophical limits of evidence-based medicine

Evidence-based medicine (EBM) has already had a profound effect on both med ical education and clinical practice. The benefits of EBM, which defines th e value of medical interventions in terms of empirical evidence from clinic al trials, are enormous and well described. Not clearly acknowledged, howev er, are the limits of EBM. An intrinsic gap exists between clinical researc h and clinical practice. Failure to recognize and account for this gap may lead to unintended and untoward consequences. Under the current understandi ng of EBM, the individuality of patients tends to be devalued, the focus of clinical practice is subtly shifted away from the care of individuals towa rd the care of populations, and the complex nature of sound clinical judgme nt is not fully appreciated. Despite its promise, EBM currently fails to pr ovide an adequate account of optimal medical practice. A broader understand ing of medical knowledge and reasoning is necessary.