Evidence-Based Medicine (EBM)

“ . . . the interpretation of data provided by a randomized controlled trial, like other forms of scientific and statistical knowledge, moves between subsidiary and focal poles of reasoning. The randomized controlled trial, like clinical intuition, is therefore also premised on the existence of unspecifiable processes. The emphasis on randomized controlled trials is an attempt to elicit clinical information under experimental conditions; yet its usage leads to errors because of the assumption that individual events are unchanging so that they may be correctly approximated with the epidemiological law under investigation. It is in dealing with the contingency inherent in the clinical encounter that clinical skill as a form of tacit knowledge becomes crucial, and is not adequately accounted for by proponents of evidence-based medicine” (Braude, 196).