Evidence based medicine and justice: a framework for looking at the impact of EBM upon vulnerable or disadvantaged groups.

This article examines the implicit promises of fairness in evidence based medicine (EBM), namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups (such as those disadvantaged by virtue of poverty, ethnicity, age, gender, mental health problems or similar) is examined. Several aspects of EBM are explored: the way evidence is created (commissioning and design of, and participation in research), and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health.