Evidence-based Medicine & Evidence-based Policy: The world’s most perfectly developed method & the 79-pound weakling?
Ray Pawson attempts a methodological comparison of evidence-based medicine (EBM) and evidence-based policy (EBP). Conventional narratives have honoured clinical (especially pharmaceutical) RCTs as the world’s most perfectly developed method. The quarrelsome, paradigm- heavy field of EBP is often dismissed as weak. The paper seeks to tear up these storylines. Pharmaceutical RCTs are only possible and meaningful because of many, prior years of basic biological and pharmacokinetic science. The underlying engine of drug developments is in fact a classic Popperian cycle. The starting point is a problem, which evokes tentative solutions. These are subjected to the process of error elimination using a whole repertoire of research methods. In the course of these activities treatments slowly improve. EBP utilises the same logic of theory testing under a method called ‘realist evaluation’.