published in Surgical Endoscopy
The idea that clinical practice should be rigorously based on the best scientific evidence is not new. What is new over the past three decades is the ever increasing pressure to contain the inflationary growth of health care costs. Until relatively recently, attempts to restrain this growth have had only minimal or transient effects. The resulting failure to control costs has led to the current climate, one that attempts to control unit price and questions the effectiveness and/or efficiency of care. In such a climate, cost effectiveness, cost benefit, cost analysis, and evidence-based medicine (EBM) are seen as only buzzwords used to disguise the ambiguity of key concepts that bedevil clinical decision making. Indeed, the key unanswered question remains: To what extent is current clinical practice in general actually supported by satisfactory scientific evidence?To answer this question, one has to turn to the branch of philosophy that deals with the varieties, sources, grounds, and validity of knowledge in addition to its application, in other words, to the epistemology of EBM.