{"id":"https://openalex.org/W1985802923","doi":"https://doi.org/10.1097/00001888-199812000-00011","title":"The philosophical limits of evidence-based medicine","display_name":"The philosophical limits of evidence-based medicine","publication_year":1998,"publication_date":"1998-12-01","ids":{"openalex":"https://openalex.org/W1985802923","doi":"https://doi.org/10.1097/00001888-199812000-00011","mag":"1985802923","pmid":"https://pubmed.ncbi.nlm.nih.gov/9883197"},"language":"en","primary_location":{"id":"doi:10.1097/00001888-199812000-00011","doi":"https://doi.org/10.1097/00001888-199812000-00011","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00001888-199812000-00011","pdf_url":null,"source":{"id":"https://openalex.org/S19793444","display_name":"Academic Medicine","issn_l":"1040-2446","issn":["1040-2446","1938-808X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic Medicine","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5015592349","display_name":"Mark R. Tonelli","orcid":"https://orcid.org/0000-0001-8402-922X","observed_orcids":["https://orcid.org/0000-0001-8402-922X"]},"institutions":[{"id":"https://openalex.org/I201448701","display_name":"University of Washington","ror":"https://ror.org/00cvxb145","country_code":"US","type":"education","lineage":["https://openalex.org/I201448701"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"M R Tonelli","raw_affiliation_strings":["Department of Medicine, University of Washington, School of Medicine, Seattle, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, University of Washington, School of Medicine, Seattle, USA","institution_ids":["https://openalex.org/I201448701"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5015592349"],"corresponding_institution_ids":["https://openalex.org/I201448701"],"apc_list":null,"apc_paid":null,"fwci":29.7176,"has_fulltext":false,"cited_by_count":392,"citation_normalized_percentile":{"value":0.99685105,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":98,"max":100},"biblio":{"volume":"73","issue":"12","first_page":"1234","last_page":"40"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11744","display_name":"Health Sciences Research and Education","score":0.9082000255584717,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11744","display_name":"Health Sciences Research and Education","score":0.9082000255584717,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.04600000008940697,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.023399999365210533,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/evidence-based-medicine","display_name":"evidence-based medicine","score":1.0},{"id":"https://openalex.org/keywords/individual-patient-care","display_name":"individual patient care","score":0.5860000252723694},{"id":"https://openalex.org/keywords/clinical-judgment","display_name":"clinical judgment","score":0.9710000157356262},{"id":"https://openalex.org/keywords/medical-education","display_name":"medical education","score":0.47999998927116394},{"id":"https://openalex.org/keywords/clinical-practice","display_name":"clinical practice","score":0.7990000247955322}],"concepts":[{"id":"https://openalex.org/C19648533","wikidata":"https://www.wikidata.org/wiki/Q691640","display_name":"Evidence-based medicine","level":3,"score":0.6559427976608276},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.6073545813560486},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.5298768281936646},{"id":"https://openalex.org/C2776291640","wikidata":"https://www.wikidata.org/wiki/Q2912517","display_name":"Value (mathematics)","level":2,"score":0.5038370490074158},{"id":"https://openalex.org/C166052673","wikidata":"https://www.wikidata.org/wiki/Q83021","display_name":"Empirical evidence","level":2,"score":0.4977128803730011},{"id":"https://openalex.org/C2776889888","wikidata":"https://www.wikidata.org/wiki/Q1135789","display_name":"Unintended consequences","level":2,"score":0.4875738024711609},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4668002724647522},{"id":"https://openalex.org/C3018838755","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Medical care","level":2,"score":0.4385172724723816},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.43298590183258057},{"id":"https://openalex.org/C204787440","wikidata":"https://www.wikidata.org/wiki/Q188504","display_name":"Alternative medicine","level":2,"score":0.4308934807777405},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.43083077669143677},{"id":"https://openalex.org/C111472728","wikidata":"https://www.wikidata.org/wiki/Q9471","display_name":"Epistemology","level":1,"score":0.3845870792865753},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.36695849895477295},{"id":"https://openalex.org/C55587333","wikidata":"https://www.wikidata.org/wiki/Q1133029","display_name":"Engineering ethics","level":1,"score":0.32016003131866455},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.23457956314086914},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.22993972897529602},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.1146012544631958},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.11100924015045166},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.0},{"id":"https://openalex.org/C138885662","wikidata":"https://www.wikidata.org/wiki/Q5891","display_name":"Philosophy","level":0,"score":0.0},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.0},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.0},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D004501","descriptor_name":"Education, Medical","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D004501","descriptor_name":"Education, Medical","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":false},{"descriptor_ui":"D004501","descriptor_name":"Education, Medical","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007400","descriptor_name":"Interprofessional Relations","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010817","descriptor_name":"Physician-Patient Relations","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011634","descriptor_name":"Public Health","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":false},{"descriptor_ui":"D011634","descriptor_name":"Public Health","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false},{"descriptor_ui":"D012106","descriptor_name":"Research","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019317","descriptor_name":"Evidence-Based Medicine","qualifier_ui":"Q000193","qualifier_name":"education","is_major_topic":true},{"descriptor_ui":"D019317","descriptor_name":"Evidence-Based Medicine","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D019317","descriptor_name":"Evidence-Based Medicine","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true}],"locations_count":5,"locations":[{"id":"doi:10.1097/00001888-199812000-00011","doi":"https://doi.org/10.1097/00001888-199812000-00011","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00001888-199812000-00011","pdf_url":null,"source":{"id":"https://openalex.org/S19793444","display_name":"Academic Medicine","issn_l":"1040-2446","issn":["1040-2446","1938-808X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic Medicine","raw_type":"journal-article"},{"id":"pmid:9883197","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/9883197","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic medicine : journal of the Association of American Medical Colleges","raw_type":"Journal Article"},{"id":"pmh:oai:philarchive.org/rec/TONTPL","doi":null,"is_oa":false,"landing_page_url":"https://philarchive.org/rec/TONTPL","pdf_url":null,"source":{"id":"https://openalex.org/S4306402130","display_name":"PhilPapers (PhilPapers Foundation)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"info:eu-repo/semantics/article"},{"id":"pmh:oai:philpapers.org/rec/TONTPL","doi":null,"is_oa":false,"landing_page_url":"https://philpapers.org/rec/TONTPL","pdf_url":null,"source":{"id":"https://openalex.org/S4306402130","display_name":"PhilPapers (PhilPapers Foundation)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"info:eu-repo/semantics/article"},{"id":"pmh:oai:repository.library.georgetown.edu:10822/918061","doi":null,"is_oa":false,"landing_page_url":"http://hdl.handle.net/10822/918061","pdf_url":null,"source":{"id":"https://openalex.org/S4306402467","display_name":"DigitalGeorgetown (Georgetown University Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I4210145449","host_organization_name":"Center for Security and Emerging Technology","host_organization_lineage":["https://openalex.org/I4210145449"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"eweb:195551","raw_type":null}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.6240000128746033,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":12,"referenced_works":["https://openalex.org/W1574703124","https://openalex.org/W1885434397","https://openalex.org/W1988365736","https://openalex.org/W1988622500","https://openalex.org/W2029728657","https://openalex.org/W2038117300","https://openalex.org/W2060589180","https://openalex.org/W2090061778","https://openalex.org/W2092467722","https://openalex.org/W2128655828","https://openalex.org/W2163269591","https://openalex.org/W2334427329"],"related_works":["https://openalex.org/W1610463472","https://openalex.org/W1449644074","https://openalex.org/W37649087","https://openalex.org/W4415349794","https://openalex.org/W8636917","https://openalex.org/W4244955503","https://openalex.org/W64895165","https://openalex.org/W151917405","https://openalex.org/W2111074322","https://openalex.org/W4232615163"],"abstract_inverted_index":{"Evidence-based":[0],"medicine":[1],"(EBM)":[2],"has":[3],"already":[4],"had":[5],"a":[6],"profound":[7],"effect":[8],"on":[9],"both":[10],"medical":[11,25,132,138],"education":[12],"and":[13,37,56,62,71,107,140],"clinical":[14,33,54,57,91,113],"practice.":[15,58,133],"The":[16],"benefits":[17],"of":[18,24,29,47,78,82,90,100,105,111,130,137],"EBM,":[19,79],"which":[20],"defines":[21],"the":[22,45,75,80,88,98,103,108],"value":[23],"interventions":[26],"in":[27],"terms":[28],"empirical":[30],"evidence":[31],"from":[32,97],"trials,":[34],"are":[35,44],"enormous":[36],"well":[38],"described.":[39],"Not":[40],"clearly":[41],"acknowledged,":[42],"however,":[43],"limits":[46],"EBM.":[48],"An":[49],"intrinsic":[50],"gap":[51,66],"exists":[52],"between":[53],"research":[55],"Failure":[59],"to":[60,69,85,125],"recognize":[61],"account":[63,129],"for":[64],"this":[65],"may":[67],"lead":[68],"unintended":[70],"untoward":[72],"consequences.":[73],"Under":[74],"current":[76],"understanding":[77,136],"individuality":[81],"patients":[83],"tends":[84],"be":[86],"devalued,":[87],"focus":[89],"practice":[92],"is":[93,115,142],"subtly":[94],"shifted":[95],"away":[96],"care":[99,104],"individuals":[101],"toward":[102],"populations,":[106],"complex":[109],"nature":[110],"sound":[112],"judgment":[114],"not":[116],"fully":[117],"appreciated.":[118],"Despite":[119],"its":[120],"promise,":[121],"EBM":[122],"currently":[123],"fails":[124],"provide":[126],"an":[127],"adequate":[128],"optimal":[131],"A":[134],"broader":[135],"knowledge":[139],"reasoning":[141],"necessary.":[143]},"counts_by_year":[{"year":2026,"cited_by_count":11},{"year":2025,"cited_by_count":9},{"year":2024,"cited_by_count":15},{"year":2023,"cited_by_count":11},{"year":2022,"cited_by_count":7},{"year":2021,"cited_by_count":10},{"year":2020,"cited_by_count":12},{"year":2019,"cited_by_count":37},{"year":2018,"cited_by_count":14},{"year":2017,"cited_by_count":9},{"year":2016,"cited_by_count":11},{"year":2015,"cited_by_count":17},{"year":2014,"cited_by_count":18},{"year":2013,"cited_by_count":11},{"year":2012,"cited_by_count":17}],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2016-06-24T00:00:00"}