Has evidence‐based medicine ever been modern? A Latour‐inspired understanding of a changing EBM
| Autor: | Sietse Wieringa, Eivind Engebretsen, Kristin Heggen, Trisha Greenhalgh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Aspects of Decision‐making: Context
Evidence and Wisdom medicine.medical_specialty Health Knowledge Attitudes Practice media_common.quotation_subject Clinical Decision-Making Alternative medicine medical research 03 medical and health sciences 0302 clinical medicine Health care Situated medicine Humans 030212 general & internal medicine Human society media_common evidence‐based medicine Evidence-Based Medicine business.industry 030503 health policy & services Health Policy Interpretation (philosophy) Modernity Public Health Environmental and Occupational Health epistemology Evidence-based medicine Demise Original Articles health care 3. Good health Epistemology philosophy of medicine Original Article 0305 other medical science business |
| Zdroj: | Journal of Evaluation in Clinical Practice |
| ISSN: | 1365-2753 1356-1294 |
| Popis: | © 2017 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd. Evidence-based health care (EBHC), previously evidence-based medicine (EBM), is considered by many to have modernized health care and brought it from an authority-based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals of a changing EBHC. In this paper, we present French philosopher Bruno Latour's vision on modernity as a framework to discuss current changes in the discourse on EBHC/EBM. Drawing on Latour's work, we argue that the early EBM movement had a strong modernist agenda with an aim to “purify” clinical reality into a dichotomy of objective “evidence” from nature and subjective “preferences” from human society and culture. However, we argue that this shift has proved impossible to achieve in reality. Several recent developments appear to point to a demise of purified evidence in the EBHC discourse and a growing recognition—albeit implicit and undertheorized—that evidence in clinical decision making is relentlessly situated and contextual. The unique, individual patient, not abstracted truths from distant research studies, must be the starting point for clinical practice. It follows that the EBHC community needs to reconsider the assumption that science should be abstracted from culture and acknowledge that knowledge from human culture and nature both need translation and interpretation. The implications for clinical reasoning are far reaching. We offer some preliminary principles for conceptualizing EBHC as a “situated practice” rather than as a sequence of research-driven abstract decisions. |
| Databáze: | OpenAIRE |
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