Evidence-Based Medicine (EBM): The (Only) Means for Distinguishing Knowledge of Medical Causation From Expert Opinion in the Courtroom

Evidence-based medicine (EBM) was first established in the 1980s when physicians and medical educators purposed to more uniformly apply standards of evidence gained from the scientific method to assess questions of medical causation. Now widely employed by physicians in medical decision making and during their selections of medical treatment, and nearly omnipresent in modern medical student education, EBM allows doctors to separate scientific facts from opinions in determining clinical treatment efficacy. Accordingly, EBM — whether in a hospital or in a courtroom — is the systematic method capable of distinguishing expert pronouncements about medical or scientific questions of causation as either (1) authority-based opinions (derived from expert intuition or reasoning, principles of pathophysiology, or inference based on experimental or observational data of insufficient quality) or (2) evidence-based conclusions (objective knowledge arising from the availability of sufficient, high-quality evidence).This article recommends that EBM should supplement ineffective legal gatekeeper rules of scientific evidence and be incorporated into the courtroom to (1) accurately distinguish medical knowledge from mere expert opinion and (2) thereby assist the court in correctly adjudicating disputed medical matters and toxic industrial or environmental exposure cases.