Hi there! Yes, I see what you mean. For me, the problem is partly that I think in this instance - EBM - "EBM" isn't a thing at all: it's more like a statement "music is a good thing and it should be one of the things that people consider when they want to be entertained, distracted or affected" and the adherents of that philosophy.
If you try to separate "it" from the practices/actions/priorities it is encouraging, then I don't think there is any "thing" left. It becomes only a vague statement of belief - something like "the best evidence should be considered along with other things" where the meaning of the component words/phrases is interpreted differently/contested anyway. Embedded in the notion are things like "there should be more rationality and probabilistic thinking rather than going with the gut/(manipulated) flow in medicine". And "effects matter and things should be rigorously evaluated and those evaluations should influence what happens next." And of course, even without the articulation of something called EBM, those things existed. EBM then is characterized by its particular "things" - in particular, the systematic review, the trial, probabilistic statistics.
What there is, is a lobby/community for particular types of changes to health research, health information, healthcare practice, health regulation/payment, health professional education etc, and the interventions being promoted that would make these things different to the way they would have been without a lobby for those changes. And if that lobby rallying around those changes that people want to see (very loosely categorized as "believing in EBM") hadn't existed, we would be better or worse off or no different, in different ways.
Tried not to use the word paradigm, but really, isn't that what's left about what "EBM" is, if it's not its interventions and its lobby/community? This thing formed, but other things would have emerged if this hadn't existed. Maybe it's neither music nor performance: it's a kind of "rules" for musicians and audience, and its school of adherents, perhaps.
Hilda
