Guest Editorial: Why do we always end up here? Evidence-based medicine’s conceptual cul-de-sacs and some off-road alternative routes

to the 2012 Olympic Stadium and right in the heart of London's vibrant and ethnically diverse East End.I am Director of the Healthcare Innovation and Policy Unit at Queen Mary.Innovation: an idea, a technology, a research discovery, a way of working-anything that is perceived as new and which requires a change of hearts and minds and structures and systems to become business as usual. 1 Policy: perhaps best defined as 'the authoritative exposition of values'. 2 Most policy is about innovation: it seeks to justify why particular new ideas, technologies, research findings or ways of working should be taken up-and therein lies a research agenda.Modern medicine, we are told, has become a victim of its own success.We have, allegedly, prolonged human life to the point at which the sick are demanding the right to die.Evidencebased decision support is so good, apparently, that patients no longer need a doctor, just a well-programmed computer.Indeed, we are approaching the time when the workings of our bodies will be programmed like a computer by technically trained doctors.Medicine, so they say, has lost its moral compass and sold out to tick-box appraisal toolkits.Is this paradox of progress all in the heads of the Luddites?Or are we experiencing a genuine and sinister erosion of medicine's core values and defining practices by new technologies in the hands of naive rationalists? 3Let me explain what I mean by 'conceptual culde-sacs'.Thomas Kuhn proposed that science progresses in paradigms-a paradigm being a set of assumptions and beliefs shared by a group of scientists about what the important questions are and how they should be tackled. 4Most scientists, most of the time, work within an existing paradigm and build rather doggedly on what has gone before.