Is Evidence Based Medicine a Form of Microfascism?


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.”


  1. The problem with EBM is, as shown in the news article about Salami slicing in published data on antipsychotic trials, is that it’s fairly easy to fake the evidence. And as shown in the rebuttal to the ADHD study published in JAMA, retractions rarely happen, rebuttals are rarely included with the original published piece, and the controversy become lost in subsequent publications. So I’ll trust evidenced based medicine when there’s substantially less evidence of manufactured data and corruption in industry.

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  2. EBM is only democratizing if you are part of the guild and part of the favored…for all others it is, indeed, a way to control and delegitimize…and for the author of the critique to dismiss the authors of the original article in the way he did at the end, shows he is doing exactly that: protecting the guild by delegitimizing and controlling who and how it is allowed to be critiqued. That doesn’t mean I’m against EBM, but like everything it is only as good as those who hold true to the best of its tenets and methods.

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