Ep. 30 Beyond EBM: Case-based reasoning and the integration of clinical knowledge

Mark Tonelli, MD

Can anyone question evidence-based medicine and not be considered some kind of fringe lunatic?  Fortunately it’s possible, as will be demonstrated by our guest, Mark Tonelli, professor of medicine from the University of Washington, and one of the earliest, most thoughtful, and most articulate academic critic of the EBM dogma.

Dr. Tonelli holds a BA in philosophy form the University of Colorado in Boulder and a medical doctorate from the University of Colorado in Denver.  He is the author of numerous peer-reviewed articles and book chapters on various aspects of medical science and medical philosophy.  His critique of EBM and his proposal for “case-based reasoning” are both cogent and compelling.


Professor Mark Tonelli’s faculty Website


NOTE: Dr. Tonelli will kindly make a copy of his book chapter on case-based reasoning available upon request.  You may contact him via his professional website above.


Watch the episode on our YouTube channel.


  1. […] podcast was an episode of The Accad and Koka Report called Beyond EBM: Case-based reasoning and the integration of clinical knowledge. Although I think the discussion has a few logical inconsistencies and mischaracterizes evidence […]

  2. Anthony M. Perry, on 10/02/2018 at 4:53 PM

    I’ve heard it argued that EBM helps to avoid too much diversity in management. That’s an argument that appeals to the bureaucrats. No matter that the results of clinical studies are often controversial, or misinterpreted, or done wrong, or are outdated or are inapplicable to the specific situation. Yes, obviously clinical studies are critically important and immensely useful but are just one piece of the puzzle.

    It was nice to hear clinical experience being validated. I made my living treating diabetes. When I first started using pump treatment decades ago I was tentative. I advised my patients about the studies that concluded multiple dose insulin injections were equally effective. As I gained experience it became clear to me that for the right person pump treatment was clearly superior and I confidently advised my patients as such. On the other hand patients came to me using pumps inappropriately. How can one evaluate such things except on an individual basis?

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