Disease specificity and evidence-based medicine: a historical perspective

This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.