By Toby Rogers at Brownstone dot org.

I. Introduction

Evidence-Based Medicine (EBM) is a relatively recent phenomenon. The term itself was not coined until 1991. It began with the best of intentions - to give frontline doctors the tools from clinical epidemiology to make science-based decisions that would improve patient outcomes. But over the last three decades, EBM has been hijacked by the pharmaceutical industry to serve the interests of shareholders rather than patients.

Today, EBM gives preference to epistemologies that favor corporate interests while instructing doctors to ignore other valid forms of knowledge and their own professional experience. This shift disempowers doctors and reduces patients to objects while concentrating power in the hands of pharmaceutical companies. EBM also leaves doctors ill-equipped to respond to the autism epidemic and unable to produce the sorts of paradigm-shifts that would be necessary to address this crisis.

In this article I will:

provide a brief history of EBM;

explain how evidence hierarchies work;

explore ten general and technical criticisms of EBM and evidence hierarchies;

examine the American Medical Association's 2002, 2008, and 2015 evidence hierarchies;

highlight the corporate takeover of EBM; and

explore the implications of these dynamics for the autism epidemic.

II. History of Evidence-Based Medicine

Medicine faces the same challenges as any other branch of knowledge - deciding what is "true" (or at least "less wrong"). Since its emergence in 1992, EBM has become the dominant paradigm in the philosophy of medicine in the United States and its impact is felt around the world (Upshur, 2003 and 2005; Reilly, 2004; Berwick, 2005; Ioannidis, 2016). Through the use of evidence hierarchies, EBM privileges some forms of evidence over others.

Hanemaayer (2016) provides a helpful genealogy of EBM. Epidemiology - "the branch of medical science that deals with the incidence, distribution, and control of disease in a population" - has been a recognized field for hundreds of years. But clinical epidemiology, defined as "the application of epidemiological principles and methods to problems encountered in clinical medicine" first emerged in the 1960s (Fletcher, Fletcher, and Wagner, 1982).

Feinstein (1967) is credited as the catalyst for the emergence and growth of this new discipline. Feinstein, in his book Clinical Judgment (1967) wrote, "Honest, dedicated clinicians today disagree on the treatment for almost every disease from the common cold to the metastatic cancer.

Our experiments in treatment were acceptable by the standards of the community, but were not reproducible by the standards of science." So Feinstein proposed a method for applying scientific criteria to clinical judgments in clinical situations.

According to Hanemaayer (2016), around the same time, David Sackett was leading the first department of clinical epidemiology at McMaster University in Canada. Sackett was influenced by Feinstein and trained an entire generation of future doctors in clinical epidemiology. In the 1970s, Archibald Cochrane expanded the use of randomized controlled trials to a broader range of medical treatments.

In 1980, the Rockefeller Foundation funded the International Clinical Epidemiology Network (INCLEN), which took the methods and philosophy of clinical epidemiology worldwide. The efforts of INCLEN would later receive the support of the US Agency for International Development, the World Health Organization, and the International Development Research Centre.

Various terms have been used to describe the methods of clinical epidemiology. Eddy (1990) used the term "evidence-based." At about the same time the residency coordinator at McMaster University, Dr. Gordon Guyatt, was referring to this growing discipline as "scientific medicine" but apparently this term never caught on with the residents (Sur and Dahm, 2011). Eventually Guyatt settled on the term "evidence-based medicine" in an article i...