Ethics and EBM: acknowledging bias, accepting difference and embracing politics.

Evidence-based medicine (EBM) has been effective because it confers both epistemic and moral authority, promising that both individual patient care and public health interventions are effective, safe and efficient, that these decisions and standards can be determined (and therefore judged) in a transparent manner and that this form of decision making is reliable, objective and value-free. The problem is that EBM refers to particular, ideologically and philosophically specific concepts of evidence, medicine and the relationship between them. The analysis of the 'ethics' of EBM, therefore, requires not only a critique of its philosophical naïvety and its attachment to modernism and positivism, but a critique of its social, cultural and political implications.