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March 10, 1993

Evidence-Based Medicine: A New Paradigm for the Patient

Author Affiliations

San Francisco, Calif

JAMA. 1993;269(10):1253. doi:10.1001/jama.1993.03500100051022

To the Editor.  —I am responding to the Evidence-Based Medicine Working Group's imprecise use of the term paradigm shift in what otherwise was an informative article.1 The authors stated that the old paradigm is represented by assumptions guiding clinical practice based on either empirical observations, rationalistic confirmation, Oslerian acumen, and common sense, or a combination thereof. In the purported new paradigm, these assumptions are grounded in the critical appraisal and correct interpretation of medical literature that can then provide the basis of underlying evidence to support and guide clinical decisions. How does the reconciliation of the age-old empiricist-rationalist debate through a systematic analysis of clinical literature represent a paradigm shift in the true Kuhnian sense? Rather than constituting a revolution, it would seem that evidence-based medicine is an example of further developing and professionalizing the prevailing paradigm through a "refinement of concepts that increasingly lessens their resemblance to their