Has evidence-based medicine ever been modern? A Latour-inspired understanding of a changing EBM

Journal of Evaluation in Clinical Practice
Sietse WieringaTrish Greenhalgh

Abstract

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 reconsid...Continue Reading

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Citations

Aug 7, 2018·Journal of Evaluation in Clinical Practice·Sietse WieringaTrish Greenhalgh
May 12, 2018·BMC Health Services Research·Ann Dadich, Navin Doloswala
Sep 27, 2018·Reviews on Recent Clinical Trials·Aynaz NouraniMasoud Solaymani Dodaran
Aug 23, 2019·Nursing Philosophy : an International Journal for Healthcare Professionals·Gill Thomson, Susan Crowther
Jul 15, 2020·Disability and Rehabilitation. Assistive Technology·Jonathan HowardJeremy J Tree
Nov 25, 2017·Health Research Policy and Systems·Maarten Olivier KokAlbertine Jantine Schuit
Feb 6, 2018·Journal of Medical Internet Research·Sietse WieringaTrisha Greenhalgh
May 26, 2018·Advances in Health Sciences Education : Theory and Practice·Patricia ThilleJenny Setchell
Sep 30, 2017·Journal of Evaluation in Clinical Practice·Michael LoughlinJonathan Fuller
Jul 15, 2021·Journal of Evaluation in Clinical Practice·Timothé Langlois-ThérienMichel Shamy
Oct 19, 2017·Musculoskeletal Science & Practice·Roger Kerry

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