In this post for BMJ Opinion, Richard Smith critiques a 2006 paper condemning evidence based medicine as an exclusionary, colonizing form of microfascism that promotes a hierarchy of knowledge in which all research besides randomized trials is deemed scientifically imperfect. While the paper does contain a kernel of truth, Smith argues that evidence based medicine is a democratizing, not authoritarian, force.
“The alternative to evidence based medicine is the expert based medicine that prevailed for centuries. With expert based medicine it is impossible for the student nurse to challenge the expert, but the evidence belongs to everybody. In the early days of evidence based medicine students and junior doctors were much more enthusiastic than the experts being displaced; they could examine the evidence and challenge the experts.”