A philosophical argument against evidence-based policy.
OBJECTIVE
Evidence-based medicine has two components. The methodological or ontological component consists of randomized controlled trials and their systematic review. This makes use of a difference-making conception of cause. But there is also a policy component that makes a recommendation for uniform intervention, based on the evidence from randomized controlled trials.


METHODS
The policy side of evidence-based medicine is basically a form of rule utilitarianism. But it is then subject to an objection from Smart that rule utilitarianism inevitably collapses. If one assumes (1) you should recommend the intervention that has brought most benefit (the core of evidence-based policy making), (2) individual variation (acknowledged by use of randomization) and (3) no intervention benefits all (contingent but true), then the objection can be brought to bear.


CONCLUSIONS
A utility maximizer should always ignore the rule in an individual case where greater benefit can be secured through doing so. In the medical case, this would mean that a clinician who knows that a patient would not benefit from the recommended intervention has good reason to ignore the recommendation. This is indeed the feeling of many clinicians who would like to offer other interventions but for an aversion to breaking clinical guidelines.
School of Economics and Business, Norwegian University of Life Sciences, Ås, Norway.
Rani Lill
RL
Anjum
School of Economics and Business, Norwegian University of Life Sciences, Ås, Norway.|Department of Philosophy, University of Durham, UK.
Stephen D
SD
Mumford
D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010686:Philosophy, Medical; D057766:Policy; D011050:Policy Making; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
clinical guidelines; evidence-based medicine; health policy