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Asking the question: What is the evidence for EBM? Comes within the scope of the following family of questions: 1) What is the evidence that asking questions is worthwhile in clinical contexts? 2) What is that evidence that evidence is (or can be) found for the clinical questions? 3) What is the evidence that the dialogue between asking questions and answering them is worth the effort? These sorts of questions are philosophical. The treatment of the questions could be answered in the following philosophical perspectives: Ethical – eg is it moral to do 1 to 3, and if so by what ethical perspective would one achieve a morally worthwhile perspective? Analytical –eg how might one use various conceptual tools in decision theory and in statistical theory to achieve 1 to 3? Political –eg who should ask the questions? who should answer them? How does society control the production and reception of evidence? How does a society deal with the dialogue between a question asked in health care and its answer? Understanding these issues are relevant to productive discussions about EBM. However, understanding is difficult for two reasons. Firstly, there is not a large body of scholarly work that addresses the ethical, analytical, or political aspects of EBM issues within the clinical medical (or nursing) field. Secondly, the pragmatics of medical health care is firmly embedded in casuistry – medical & nursing people remember a case far better than they remember the details of an RCT. There are many reasons for this but the most powerful is a historical one health care has a very long history of basing its learning and research on case-based activity. The history of EBM is short. My contention from a primary care point of view is that all research, teaching, and clinical perspectives on EBM need serious philosophical work. Dr Marjan Kljakovic Senior Lecturer in General Practice Convenor of Evidence Based Medicine Teaching Wellington School of Medicine and Health Sciences University of Otago New Zealand