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Can evidence-based medicine implicitly rely on current concepts of disease or does it have to develop its own definition?
  1. Andreas Gerber1,
  2. Frieder Hentzelt2,
  3. Karl W Lauterbach1
  1. 1Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne/Koeln, Germany
  2. 2Allgemeines Krankenhaus Hamburg-Barmbek/General Hospital Hamburg-Barmbek, Rübenkamp 148, Hamburg, Germany
  1. Correspondence to:
 Dr A Gerber
 Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Strasse 176–178, 50935 Cologne/Koeln, Germany; gerber{at}


Decisions in healthcare are made against the background of cultural and philosophical definitions of disease, sickness and illness. These concepts or definitions affect both health policy (macro level) and research (meso level), as well as individual encounters between patients and physicians (micro level). It is therefore necessary for evidence-based medicine to consider whether any of the definitions underlying research prior to the hierarchisation of knowledge are indeed compatible with its own epistemological principles.

  • EbM, evidence-based medicine
  • RCT, randomised clinical trial

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  • i We use the terms “concept” and “definition” of health or disease interchangeably throughout this article. We do not enter the discussion on the relationship between concept and model(s) of disease (cp Hofmann,2 p 228).

  • ii We would like to affirm at this point that we are certainly in favour of patients’/consumers’ involvement in research, as we are aware that patients can indeed push for very valuable questions to be studied. It should however be clear that this requires an agenda detailing how and which patients’ preferences are to be incorporated into the planning and conducting of research projects (fig 3).

  • iii This also holds for pre-EbM medicine, though with EbM the situation is tapered, since here research from different backgrounds is collected.

  • iv We refer to “traditional” medicine that relies on individual clinical experience and/or on non-structured or subjectively structured bodies of medical knowledge. Pre-EbM medicine seems to be the term with the least pejorative connotations.

  • v We cannot enter the whole debate on philosophy of science with the controversy of critical rationalism.

  • vi We are aware that this is a new approach to the philosophical evaluation of EbM in relation to medical knowledge. We are currently working on a contribution to the different concepts of EbM held by adherents and opponents.

  • vii We admit that nowadays pathophysiologists and, especially, pharmacologists also stress that there are mechanisms that are not universal but are unique to age groups, ethnic groups, etc.

  • viii In how far the so-called biomedical and naturalist concepts of disease rather favour a paternalistic mode of practising medicine should be subject to further research, as EbM is discussed in the context of shared decision making.

  • ix A further discussion of the ethical implications of differing concepts of disease would be an interesting topic, yet cannot be analysed on the grounds of our initial question.

  • x The German language only has the term “Krankheit,” in contrast to the English concepts of disease, sickness and illness.

  • xi At this point, we cannot problematise Virchow’s concept of “nature”.

  • Competing interests: None.