EVIDENCE-BASED MEDICINE AND EVIDENCE-BASED PUBLIC HEALTH

In this chapter I outline and critique a movement in (and attitude towards) medicine that has proven influential and controversial in equal measure: Evidence-Based Medicine (EBM) and its public health equivalent Evidence-Based Public Health (EBPH). EBM promotes the judicious and explicit use of “best evidence” in clinical decision-making, where “best evidence” comprises primarily that obtained from randomized controlled trials (RCTs) and other large-scale clinical studies. It further claims that over-reliance on pathomechanistic reasoning and clinical experience should be avoided. EBM, and the hierarchy of forms of evidence that underpins it, has inspired a similar movement in public health. Like EBM, EBPH proposes a hierarchy of evidence, and it is this hierarchy that should ground important public health policy decisions. In this chapter I briefly outline the history of EBM and the hierarchy of evidence that lies at its core and consider three major objections to the movement. I present its public health equivalent, EBPH, highlighting the core differences in their respective hierarchies and demonstrating that at least some of the issues facing EBM are inapplicable in the public health context. I conclude that adherence to EBPH could help avoid many of the mistakes commonly made by public health policymakers.