A short History of evidence-based Medicine in Germany

The text reflects the history of evidence-based medicine (EbM) in Germany from the mid1990ies to the present. Here, EbM has established itself first and successfully as evidence-based health care, i.e. above the clinical level and within the normative context of Germany's social law. The distance between EbM and clinic, perceptible from the beginning, has seemingly not much changed. EbM had more influence on clinical jargon than clinical practice. This is on the one hand a result of its introduction, top down" and on the other of a scientific tradition of German clinical medicine. Until the 1980ies the introduction of new diagnostic and therapeutic methods has been relying (and actually relies again) stronger on biomedical deductions than empirical testing. An additional factor are conflicts between EbM and the increasing economisation of the clinic. Lastly, developments within EbM itself lead to alienation from the clinic, its self-concept, pragmatic logic, and practices.