title: Evidence-based medicine: is it a bridge too far?
abstract: OBJECTIVE
  This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science.
  
  
  RESULTS
  The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context.
  
  
  CONCLUSIONS
  EBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.
authors.affiliation: Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia. ana.fernandez@sydney.edu.au.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernandez
authors.affiliation: Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia. jp.sturmberg@gmail.com.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sturmberg
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. sue.lukersmith@sydney.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Lukersmith
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. ros.madden@sydney.edu.au.
authors.forename: Rosamond
authors.initials: R
authors.lastname: Madden
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia. gtor2513@uni.sydney.edu.au.
authors.forename: Ghazal
authors.initials: G
authors.lastname: Torkfar
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia. ruth.colagiuri@sydney.edu.au.
authors.forename: Ruth
authors.initials: R
authors.lastname: Colagiuri
authors.affiliation: Centre for Disability Research and Policy-Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. luis.salvador-carulla@sydney.edu.au.
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
mesh_terms: D003695:Delivery of Health Care; D019317:Evidence-Based Medicine; D006801:Humans; D019359:Knowledge; D057170:Translational Research, Biomedical