Between Rational Beliefs and the Bedside: Breaking the Boundaries and Bridging the Breach

Science is privileged to explicate and fully illuminate the single truth of the real, the real being generally an opaque black box with no hitherto available information. In what seem to be ideological arguments posturing as matters of truth, medicine, like all scientific domains, need to evaluate its practices based on proof derived from empiricism employing robust scientific tools. This is the basis for the doctrine of evidence-based medicine (EBM), which essentially refers to objectively evaluating the efficacy, safety and cost of medical practices and procedures with established scientific modelling techniques and basing clinical practice on such inferences. Another concept in clinical medicine, perhaps much older, perennial and pervasive than EBM, is based on “rational beliefs” derived from a combination, in various proportions, of clinical expertise, mechanistic reasoning, and some lower-grade evidence not amounting to EBM in its classical sense (randomized controlled trials, systematic reviews and meta-analyses). This less stringent, down-the-pyramid evidence may involve case studies, nonrandomized case series or observational studies. …