Between the years 1980-1990, the Osheroff case aroused the emotions of many psychiatrists (Kaasenbrood 1995: 10-15). Osheroff suffered from serious depression. Following the failure of treatment with medication, he was admitted to Chestnut Lodge, where he was treated for seven months using clinical psychotherapy without medication. His condition deteriorated to such an extent that his family requested a different treatment. When this request was not honoured, the family decided to have Osheroff transferred to another clinic. Here he was treated with medication. Osheroff's condition quickly improved, and after three months he was discharged completely free of symptoms. However, this is the beginning and not the end of the story.

Osheroff thought he had suffered injuries while at Chestnut Lodge and decided to take them to court. The absence of efficacy studies on psychotherapeutic treatment should have been reason enough for Chestnut Lodge to treat him with antidepressants. The effecacy of these drugs is firmly established (Klerman 1990). The counsel for the Chestnut Lodge defence argued that the claims of the efficacy of medication was too limited. Clinical treatment should also be aimed at professional standards and the ‘collective sense of the profession’ (Stone 1990).

The Osheroff case illustrates in a nutshell the main aspects of the later controversy on evidence-based policy. Evidence-based policy takes the view that professional practice should be in concordance with scientific evidence. This policy is widely accepted to the extent that it has reached the characteristics of a paradigm. However, it is not clear what this paradigm actually looks like (Sehon & Stanley 2003). Do we all consider the same paradigm when we talk about evidence-based policy? Definitely not. In this chapter we will describe two different, basically opposite, views on evidence-based policy: one starts with the answers and the other with the questions.

First Impressions of Evidence-Based Policy

The term evidence-based has become a familiar one over the last 15 years or so. While in 1992, the reputed databank Medline contained only one article on the subject, this number had risen to over 13,000 by February 2004 (Strauss et al. 2005). In addition to evidence-based medicine, many other variants on the term have been introduced in recent years.