Abstract

Proponents of evidence-based medicine have recently suggested a “4S” approach to clinical decision making in which physicians are advised to rely on increasingly abstract summaries of the available research evidence. This retreat from the original data of medical research is ill-advised: it extends an unjustified evidence hierarchy, overestimates the role of computer systems, divides communities, discards evidence, ignores contexts, and devalues broad critical evaluation. I draw upon feminist social epistemology to evaluate the 4S approach to EBM and to suggest means for improving the evidence base of medical research and practice.