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2 Rethinking bias and truth in EBM
  1. Sietse Wieringa1,2,
  2. Eivind Engebretsen3,
  3. Kristin Heggen2,
  4. Trish Greenhalgh1
  1. 1University of Oxford, Oxford, UK
  2. 2University of Oslo, Oslo, Norway
  3. 3University of Oslo, Norway, Norway


Objectives Abstract In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence-based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of ‘bias.’ To prevent unwarranted relativism and make better inferences in clinical practice, clinicians may benefit from a closer analysis of existing assumptions about truth, validity, and reality. Here we give a brief overview of several important theories of truth, notably the ideal limit theorem (which assumes an ultimate and absolute truth towards which scientific inquiry progresses), the dominant way truth is conceptualized in the discourse and practice of EBHC.

Method We draw on Belgian philosopher Isabelle Stengers’ work to demonstrate that bias means one thing if one assumes a world of hard facts ‘out there,’ waiting to be col- lected. It means something different if one takes a critical view of the knowledge- power complex in research trials. Bias appears to have both an unproductive aspect and a productive aspect as argued by Stengers and others: Facts are not absolute but result from an interest, or interesse: a bias towards a certain line of questioning that cannot be eliminated.

Results The duality that Stengers’ view invokes draws attention to and challenges the assumptions underlying the ideal limit theory of truth in several ways. Most impor- tantly, it casts doubt on the ideal limit theory as it applies to the single case scenario of the clinical encounter, the cornerstone of EBHC. To the extent that the goal of EBHC is to support inferencing in the clinical encounter, then the ideal limit as the sole concept of truth appears to be conceptually insufficient.

Conclusions We contend that EBHC could usefully incorporate a more pluralist understanding of truth and bias and provide an example how this would work out in a clinical scenario.

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