La médecine fondée sur les preuves : un outil de contrôle des soins de santé ? Application au traitement de la douleur

Evidence-based medicine (EBM) is described by its proponents as the only tool allowing a valid and unbiased evaluation of diagnostic and therapeutic medical procedures. As a consequence, numerous health-care managers consider it a method of distinguishing between effective procedures deserving funding and those found ineffective. Several authors, however, have questioned the capacity of EBM to achieve these objectives on epistemological, methodological, ethical, political, economical, anthropological and sociological grounds. A review of their objections shows that, although EBM is a powerful tool for analysing specific, well-defined questions, a wide range of clinical problems, such as chronic pain management, cannot be adequately assessed by its methods. The dogmatic use of EBM, therefore, is philosophically and scientifically unsound, alienating for patients and clinicians, and unethical. It contributes to the expansion of the biomedical model of clinical care at the expense of the more appropriate biopsychosocial model