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Arch Hellen Med, 22(3), May-June 2005, 307-316


Εvidence based medicine: A critical overview. The new paradigm of clinical medicine

Konstantopouleio General Hospital "Agia Olga", N. Ionia, Athens, Greece

This paper is a critical review of the new theory of evidence based medicine (EBM) and discusses the emergence of a new model of clinical medicine. Evidence based medicine has become a popular theory. The concept of evidence is developed, specifically regarding its relation to information with which it has common aspects. From the epistemological point of view, evidence is relative to the belief one formulates about an event and this belief is justified scientifically if and only if it is based on evidence that supports that belief. The clinician, based on appropriately assessed and evaluated evidence, is able to formulate a justified opinion, a belief regarding diagnosis, therapy or prognosis, that has a high probability of being correct. If the existing evidence E scientifically supports the belief B then E renders B probable. Nowadays EBM is a necessity because health consumers want health quality in proportion to the money spent for health care, and because medical information has reached astronomical dimensions, the traditional sources of medical information are outmoded (textbooks), often wrong (specialists), ineffective (conferences), very extensive and of varying credibility (medical journals). EBM aspires to become the new scientific model of clinical medicine but does not have the generality and depth that would justify this ambition. In the best case EBM is a good method of systemic research and assessment of the current bibliography. The author proposes that the new scientific paradigm of clinical medicine should be based on what is called clinical logic, which describes the way that decisions should be made, not on a theoretical basis but in real time and actual conditions. Clinical logic embodies clinical judgment as the hard core of the method and integrates the principles of syllogism as they are expressed through hypothetico-deductive reasoning, with which are interwoven the probability calculation, the theory of medical decision making, information theory and utility theory.

Key words: Clinical logic, Evidence based medicine, Evidence, Information, Scientific clinical medicine.

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