Philip Dawid, William Twining, and Mimi Vasilaki (eds)
- Published in print:
- 2011
- Published Online:
- January 2013
- ISBN:
- 9780197264843
- eISBN:
- 9780191754050
- Item type:
- book
- Publisher:
- British Academy
- DOI:
- 10.5871/bacad/9780197264843.001.0001
- Subject:
- Sociology, Methodology and Statistics
Evidence — its nature and interpretation — is the key to many topical debates and concerns such as global warming, evolution, the search for weapons of mass destruction, DNA profiling, and ...
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Evidence — its nature and interpretation — is the key to many topical debates and concerns such as global warming, evolution, the search for weapons of mass destruction, DNA profiling, and evidence-based medicine. In 2004, University College London launched a cross-disciplinary research programme ‘Evidence, Inference and Enquiry’ to explore the question: ‘Can there be an integrated multidisciplinary science of evidence?’ While this question was hotly contested and no clear final consensus emerged, much was learned on the journey. This book, based on the closing conference of the programme held at the British Academy in December 2007, illustrates the complexity of the subject, with seventeen chapters written from a diversity of perspectives including Archaeology, Computer Science, Economics, Education, Health, History, Law, Psychology, Philosophy, and Statistics. General issues covered include principles and systems for handling complex evidence, evidence for policy-making, and human evidence-processing, as well as the very possibility of systematising the study of evidence.Less
Evidence — its nature and interpretation — is the key to many topical debates and concerns such as global warming, evolution, the search for weapons of mass destruction, DNA profiling, and evidence-based medicine. In 2004, University College London launched a cross-disciplinary research programme ‘Evidence, Inference and Enquiry’ to explore the question: ‘Can there be an integrated multidisciplinary science of evidence?’ While this question was hotly contested and no clear final consensus emerged, much was learned on the journey. This book, based on the closing conference of the programme held at the British Academy in December 2007, illustrates the complexity of the subject, with seventeen chapters written from a diversity of perspectives including Archaeology, Computer Science, Economics, Education, Health, History, Law, Psychology, Philosophy, and Statistics. General issues covered include principles and systems for handling complex evidence, evidence for policy-making, and human evidence-processing, as well as the very possibility of systematising the study of evidence.
Vincanne Adams
- Published in print:
- 2013
- Published Online:
- October 2017
- ISBN:
- 9780691157382
- eISBN:
- 9781400846801
- Item type:
- chapter
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691157382.003.0004
- Subject:
- Anthropology, Social and Cultural Anthropology
This chapter examines the impact of “evidence-based medicine” (EBM) on global public health. An epistemic transformation in the field of global health is underway, and it argues that the impact of ...
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This chapter examines the impact of “evidence-based medicine” (EBM) on global public health. An epistemic transformation in the field of global health is underway, and it argues that the impact of EBM has been twofold: (1) the creation of an experimental metric as a means of providing health care; and (2) a shift in the priorities of caregiving practices in public health such that “people [no longer] come first.” The production of experimental research populations in and through EBM helps constitute larger fiscal transformations in how we do global health. Notably, EBM has created a platform for the buying and selling of truth and reliability, abstracting clinical caregiving from the social relationships on which they depend.Less
This chapter examines the impact of “evidence-based medicine” (EBM) on global public health. An epistemic transformation in the field of global health is underway, and it argues that the impact of EBM has been twofold: (1) the creation of an experimental metric as a means of providing health care; and (2) a shift in the priorities of caregiving practices in public health such that “people [no longer] come first.” The production of experimental research populations in and through EBM helps constitute larger fiscal transformations in how we do global health. Notably, EBM has created a platform for the buying and selling of truth and reliability, abstracting clinical caregiving from the social relationships on which they depend.
Ross C. Brownson, Elizabeth A. Baker, Terry L. Leet, Kathleen N. Gillespie, and William R. True
- Published in print:
- 2010
- Published Online:
- January 2011
- ISBN:
- 9780195397895
- eISBN:
- 9780199827183
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195397895.003.0001
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter includes five sections which cover the following topics: (1) the relevant background issues, including definitions, providing an overview of evidence-based medicine, and other concepts ...
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This chapter includes five sections which cover the following topics: (1) the relevant background issues, including definitions, providing an overview of evidence-based medicine, and other concepts underlying evidence-based public health (EBPH); (2) several key characteristics of an evidence-based process; (3) analytic tools to enhance the uptake of EBPH; (4) a brief sketch of a framework for EBPH in public health practice; and (5) a summary of barriers and opportunities for widespread implementation of evidence-based approaches. A big goal of this introductory chapter is to move the process of decision making toward a proactive approach that incorporates effective use of scientific evidence and data.Less
This chapter includes five sections which cover the following topics: (1) the relevant background issues, including definitions, providing an overview of evidence-based medicine, and other concepts underlying evidence-based public health (EBPH); (2) several key characteristics of an evidence-based process; (3) analytic tools to enhance the uptake of EBPH; (4) a brief sketch of a framework for EBPH in public health practice; and (5) a summary of barriers and opportunities for widespread implementation of evidence-based approaches. A big goal of this introductory chapter is to move the process of decision making toward a proactive approach that incorporates effective use of scientific evidence and data.
Sue Dopson and Louise Fitzgerald
- Published in print:
- 2005
- Published Online:
- September 2007
- ISBN:
- 9780199259014
- eISBN:
- 9780191718113
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199259014.001.0001
- Subject:
- Business and Management, Public Management
Health services can and should be improved by applying research findings about best practice. This book explores why it proves notoriously difficult to implement change based on research evidence in ...
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Health services can and should be improved by applying research findings about best practice. This book explores why it proves notoriously difficult to implement change based on research evidence in the face of strong professional views and complex organizational structures. It draws on a large body of evidence acquired in the course of nearly fifty case studies using data from 1,400 interviews with doctors, nurses, and managers, as well as observations and documentary analysis. Using qualitative methods to study hospital and primary care settings, the book aims to shed light on why attempts to introduce evidence-based practice in the UK NHS succeeded in some cases where in others it faltered. By opening up the intricacies and complexities of change in the NHS, it reveals the limitations of simplistic approaches to implementing research or introducing evidence-based health care. The book provides an analysis rooted in a range of theoretical perspectives that underlines the intimate links between organizational structures and cultures and the utilization of knowledge, and draws conclusions significant for other areas of public management. The findings have implications for the utilization of knowledge in situations where there is a professional tradition working within a politically sensitive blend of public service, managerial accountability, and technical expertise.Less
Health services can and should be improved by applying research findings about best practice. This book explores why it proves notoriously difficult to implement change based on research evidence in the face of strong professional views and complex organizational structures. It draws on a large body of evidence acquired in the course of nearly fifty case studies using data from 1,400 interviews with doctors, nurses, and managers, as well as observations and documentary analysis. Using qualitative methods to study hospital and primary care settings, the book aims to shed light on why attempts to introduce evidence-based practice in the UK NHS succeeded in some cases where in others it faltered. By opening up the intricacies and complexities of change in the NHS, it reveals the limitations of simplistic approaches to implementing research or introducing evidence-based health care. The book provides an analysis rooted in a range of theoretical perspectives that underlines the intimate links between organizational structures and cultures and the utilization of knowledge, and draws conclusions significant for other areas of public management. The findings have implications for the utilization of knowledge in situations where there is a professional tradition working within a politically sensitive blend of public service, managerial accountability, and technical expertise.
Jennifer Radden (ed.)
- Published in print:
- 2004
- Published Online:
- January 2009
- ISBN:
- 9780195149531
- eISBN:
- 9780199870943
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195149531.003.0017
- Subject:
- Philosophy, Philosophy of Mind
Values-based medicine (VBM) is the theory and practice of effective health-care decision making for situations in which legitimately different (and hence potentially conflicting) value perspectives ...
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Values-based medicine (VBM) is the theory and practice of effective health-care decision making for situations in which legitimately different (and hence potentially conflicting) value perspectives are in play. As a theory, VBM is the values counterpart of Evidence-Based Medicine (EBM). VBM and EBM are both responses to the growing complexity of decision making in health care: EBM is a response to the growing complexity of the relevant facts; VBM is a response to the growing complexity of the relevant values. As a practice, VBM is a skills-based counterpart of the currently dominant quasi-legal form of clinical bioethics. VBM emphasizes the importance of good process in the form particularly of improved clinical practice skills. This chapter discusses the ten principles of VBM.Less
Values-based medicine (VBM) is the theory and practice of effective health-care decision making for situations in which legitimately different (and hence potentially conflicting) value perspectives are in play. As a theory, VBM is the values counterpart of Evidence-Based Medicine (EBM). VBM and EBM are both responses to the growing complexity of decision making in health care: EBM is a response to the growing complexity of the relevant facts; VBM is a response to the growing complexity of the relevant values. As a practice, VBM is a skills-based counterpart of the currently dominant quasi-legal form of clinical bioethics. VBM emphasizes the importance of good process in the form particularly of improved clinical practice skills. This chapter discusses the ten principles of VBM.
Richard S. W. Smith
- Published in print:
- 2011
- Published Online:
- May 2016
- ISBN:
- 9780262016032
- eISBN:
- 9780262298957
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262016032.003.0016
- Subject:
- Psychology, Health Psychology
Studies consistently show that health care practitioners are poor at processing statistical information on risk. Indeed, almost everybody in health care, apart from a few people with advanced ...
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Studies consistently show that health care practitioners are poor at processing statistical information on risk. Indeed, almost everybody in health care, apart from a few people with advanced training, is poor at processing statistical information. The inability to process statistical information among health care practitioners is one cause of patients failing to receive optimal care. But there are many others, including a flawed and biased information base, unawareness of evidence, unwillingness to accept the evidence, lack of applicability of the evidence, inability to implement treatments, failures to act, unwillingness of patients to accept evidence, and failure to adhere to treatments. Commissioners of health care and those who set policy may be in a much stronger position than practitioners to follow evidence, as they have access to expert advice and are not under the same time pressures as practitioners. The reductionist ideas of evidence-based medicine, however, are not simply applied in commissioning and the making of policy. Improvement is most likely to come with a systems approach, making it easy for practitioners to use interventions based on evidence and more difficult to use those not based on evidence.Less
Studies consistently show that health care practitioners are poor at processing statistical information on risk. Indeed, almost everybody in health care, apart from a few people with advanced training, is poor at processing statistical information. The inability to process statistical information among health care practitioners is one cause of patients failing to receive optimal care. But there are many others, including a flawed and biased information base, unawareness of evidence, unwillingness to accept the evidence, lack of applicability of the evidence, inability to implement treatments, failures to act, unwillingness of patients to accept evidence, and failure to adhere to treatments. Commissioners of health care and those who set policy may be in a much stronger position than practitioners to follow evidence, as they have access to expert advice and are not under the same time pressures as practitioners. The reductionist ideas of evidence-based medicine, however, are not simply applied in commissioning and the making of policy. Improvement is most likely to come with a systems approach, making it easy for practitioners to use interventions based on evidence and more difficult to use those not based on evidence.
Richard F. Heller
- Published in print:
- 2005
- Published Online:
- September 2009
- ISBN:
- 9780198529743
- eISBN:
- 9780191723919
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198529743.003.0001
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
Why do we need to consider evidence for population health and how can it draw on the success of evidence-based medicine? This chapter describes the Population Health Evidence Cycle: Ask, collect; ...
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Why do we need to consider evidence for population health and how can it draw on the success of evidence-based medicine? This chapter describes the Population Health Evidence Cycle: Ask, collect; understand; use.Less
Why do we need to consider evidence for population health and how can it draw on the success of evidence-based medicine? This chapter describes the Population Health Evidence Cycle: Ask, collect; understand; use.
Miriam Solomon
- Published in print:
- 2015
- Published Online:
- June 2015
- ISBN:
- 9780198732617
- eISBN:
- 9780191796838
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198732617.003.0005
- Subject:
- Philosophy, Metaphysics/Epistemology, Philosophy of Science
This chapter begins with an account of the development of the elements of evidence-based medicine: the randomized controlled trial, evidence hierarchies, meta-analysis, and systematic review. It ...
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This chapter begins with an account of the development of the elements of evidence-based medicine: the randomized controlled trial, evidence hierarchies, meta-analysis, and systematic review. It discusses the relationship of evidence-based medicine to the medical decision-making movement. It focuses on one criticism of evidence-based medicine: the claim that evidence-based medicine ignores the basic sciences that guide both research and clinical practice. This is because evidence hierarchies put “pathophysiological reasoning” at the bottom, or leave it off the hierarchy altogether. Several philosophers of science suggest that this be remedied by adding some high-quality “mechanistic evidence” to the middle or upper levels of the evidence hierarchy. The chapter argues instead that we regard evidence-based medicine as only one of the methods needed in medicine.Less
This chapter begins with an account of the development of the elements of evidence-based medicine: the randomized controlled trial, evidence hierarchies, meta-analysis, and systematic review. It discusses the relationship of evidence-based medicine to the medical decision-making movement. It focuses on one criticism of evidence-based medicine: the claim that evidence-based medicine ignores the basic sciences that guide both research and clinical practice. This is because evidence hierarchies put “pathophysiological reasoning” at the bottom, or leave it off the hierarchy altogether. Several philosophers of science suggest that this be remedied by adding some high-quality “mechanistic evidence” to the middle or upper levels of the evidence hierarchy. The chapter argues instead that we regard evidence-based medicine as only one of the methods needed in medicine.
John S. Haller
- Published in print:
- 2014
- Published Online:
- November 2015
- ISBN:
- 9780231169042
- eISBN:
- 9780231537704
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231169042.003.0001
- Subject:
- Public Health and Epidemiology, Public Health
This chapter recounts the emergence of orthodox medicine. Medical care and medical education emerged as a scientific enterprise in the last quarter of the nineteenth century, with the help of the ...
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This chapter recounts the emergence of orthodox medicine. Medical care and medical education emerged as a scientific enterprise in the last quarter of the nineteenth century, with the help of the advances in germ theory, anti-septic techniques, hygiene, anesthesia, and surgery. By the turn of the twentieth century, orthodox medicine succeeded in eliminating a number of unconventional therapies, challenging philosophy-based practices through “evidence-based medicine” (EBM). Biomedicine treated disease as a biochemical phenomenon that could be classified into discrete categories of causation using standardized, objectified, and technologically validated biochemical treatments and mechanisms. This led to the evolution of clinical trials, such as the blind or masked (placebo) assessment; the double-blind, placebo-controlled randomized clinical trial (RCT); and the so-called Cochrane Collaboration, which incorporated meta-analysis to support RCT's predictions.Less
This chapter recounts the emergence of orthodox medicine. Medical care and medical education emerged as a scientific enterprise in the last quarter of the nineteenth century, with the help of the advances in germ theory, anti-septic techniques, hygiene, anesthesia, and surgery. By the turn of the twentieth century, orthodox medicine succeeded in eliminating a number of unconventional therapies, challenging philosophy-based practices through “evidence-based medicine” (EBM). Biomedicine treated disease as a biochemical phenomenon that could be classified into discrete categories of causation using standardized, objectified, and technologically validated biochemical treatments and mechanisms. This led to the evolution of clinical trials, such as the blind or masked (placebo) assessment; the double-blind, placebo-controlled randomized clinical trial (RCT); and the so-called Cochrane Collaboration, which incorporated meta-analysis to support RCT's predictions.
Miriam Solomon
- Published in print:
- 2015
- Published Online:
- June 2015
- ISBN:
- 9780198732617
- eISBN:
- 9780191796838
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198732617.003.0001
- Subject:
- Philosophy, Metaphysics/Epistemology, Philosophy of Science
Chapter 1 introduces consensus conferences, evidence-based medicine, translational medicine and narrative medicine. It shows that each was introduced with claims about how transformative for medicine ...
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Chapter 1 introduces consensus conferences, evidence-based medicine, translational medicine and narrative medicine. It shows that each was introduced with claims about how transformative for medicine it would prove to be. It motivates the book by raising initial questions about each method that are not answered by the current literature. The traditional bifurcation between the art and the science of medicine is an obstacle to a fuller understanding of the methods. The tools of recent philosophy of science, integrated history and philosophy of science, science and technology studies and, most specifically, historical epistemology, guides the investigation. An outline of the contents, chapters, and conclusions is given.Less
Chapter 1 introduces consensus conferences, evidence-based medicine, translational medicine and narrative medicine. It shows that each was introduced with claims about how transformative for medicine it would prove to be. It motivates the book by raising initial questions about each method that are not answered by the current literature. The traditional bifurcation between the art and the science of medicine is an obstacle to a fuller understanding of the methods. The tools of recent philosophy of science, integrated history and philosophy of science, science and technology studies and, most specifically, historical epistemology, guides the investigation. An outline of the contents, chapters, and conclusions is given.
Miriam Solomon
- Published in print:
- 2015
- Published Online:
- June 2015
- ISBN:
- 9780198732617
- eISBN:
- 9780191796838
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198732617.001.0001
- Subject:
- Philosophy, Metaphysics/Epistemology, Philosophy of Science
Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods in medicine. This book explores their origins and aims, their ...
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Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods in medicine. This book explores their origins and aims, their epistemic strengths, and their epistemic weaknesses. The book argues that the familiar dichotomy between the art and the science of medicine is not adequate for understanding this methodological pluralism. The book begins by tracing the development of medical consensus conferences, from their beginning at the United States’ National Institutes of Health in 1977, to their widespread adoption in national and international contexts. It discusses consensus conferences as social epistemic institutions designed to embody democracy and achieve objectivity. Evidence-based medicine, which developed next, ranks expert consensus at the bottom of the evidence hierarchy, thus challenging the authority of consensus conferences. Evidence-based medicine has transformed both medical research and clinical medicine in many positive ways, but it has also been accused of creating an intellectual hegemony that has marginalized crucial stages of scientific research, particularly scientific discovery. Translational medicine is understood as a response to the shortfalls of both consensus conferences and evidence-based medicine. Narrative medicine is the most prominent recent development in the medical humanities. Its central claim is that attention to narrative is essential for patient care. The book argues that the differences between narrative medicine and the other methods have been exaggerated, and offers a pluralistic account of how all the methods interact and sometimes conflict. The result yields suggestions for how to improve medical knowledge and understand medical controversies.Less
Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods in medicine. This book explores their origins and aims, their epistemic strengths, and their epistemic weaknesses. The book argues that the familiar dichotomy between the art and the science of medicine is not adequate for understanding this methodological pluralism. The book begins by tracing the development of medical consensus conferences, from their beginning at the United States’ National Institutes of Health in 1977, to their widespread adoption in national and international contexts. It discusses consensus conferences as social epistemic institutions designed to embody democracy and achieve objectivity. Evidence-based medicine, which developed next, ranks expert consensus at the bottom of the evidence hierarchy, thus challenging the authority of consensus conferences. Evidence-based medicine has transformed both medical research and clinical medicine in many positive ways, but it has also been accused of creating an intellectual hegemony that has marginalized crucial stages of scientific research, particularly scientific discovery. Translational medicine is understood as a response to the shortfalls of both consensus conferences and evidence-based medicine. Narrative medicine is the most prominent recent development in the medical humanities. Its central claim is that attention to narrative is essential for patient care. The book argues that the differences between narrative medicine and the other methods have been exaggerated, and offers a pluralistic account of how all the methods interact and sometimes conflict. The result yields suggestions for how to improve medical knowledge and understand medical controversies.
Sue Dopson and Louise Fitzgerald
- Published in print:
- 2005
- Published Online:
- September 2007
- ISBN:
- 9780199259014
- eISBN:
- 9780191718113
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199259014.003.0001
- Subject:
- Business and Management, Public Management
The focus of the book is the issue of how to diffuse and implement innovations. This has become a burgeoning area of research in many organizations including health care. This chapter introduces the ...
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The focus of the book is the issue of how to diffuse and implement innovations. This has become a burgeoning area of research in many organizations including health care. This chapter introduces the structure of the book and raises key issues.Less
The focus of the book is the issue of how to diffuse and implement innovations. This has become a burgeoning area of research in many organizations including health care. This chapter introduces the structure of the book and raises key issues.
Colleen Derkatch
- Published in print:
- 2016
- Published Online:
- September 2016
- ISBN:
- 9780226345840
- eISBN:
- 9780226345987
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226345987.003.0002
- Subject:
- History, History of Science, Technology, and Medicine
This chapter sets the groundwork for answering the book’s central question, How does the notion of evidence determine the boundaries of biomedicine, from expert to public contexts? It explains the ...
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This chapter sets the groundwork for answering the book’s central question, How does the notion of evidence determine the boundaries of biomedicine, from expert to public contexts? It explains the rhetorical significance of terms such as “evidence” and “boundaries” within biomedicine and medical and professional discourse. Contemporary debates about complementary and alternative medicine (CAM) are shaped by the emergence of Evidence-Based Medicine as a qualitatively new model of medical practice, in which quantitative research data derived from clinical trials abstract medical decision-making from the physicians and researchers who engage in it. This chapter shows how recourse to “the evidence” in debates about CAM interventions can operate as a strategy of exclusion, wherein arguments about whether or not a given health practice is safe and effective are embedded within the medical-disciplinary matrices out of which they emerge.Less
This chapter sets the groundwork for answering the book’s central question, How does the notion of evidence determine the boundaries of biomedicine, from expert to public contexts? It explains the rhetorical significance of terms such as “evidence” and “boundaries” within biomedicine and medical and professional discourse. Contemporary debates about complementary and alternative medicine (CAM) are shaped by the emergence of Evidence-Based Medicine as a qualitatively new model of medical practice, in which quantitative research data derived from clinical trials abstract medical decision-making from the physicians and researchers who engage in it. This chapter shows how recourse to “the evidence” in debates about CAM interventions can operate as a strategy of exclusion, wherein arguments about whether or not a given health practice is safe and effective are embedded within the medical-disciplinary matrices out of which they emerge.
John S. Haller
- Published in print:
- 2014
- Published Online:
- November 2015
- ISBN:
- 9780231169042
- eISBN:
- 9780231537704
- Item type:
- chapter
- Publisher:
- Columbia University Press
- DOI:
- 10.7312/columbia/9780231169042.003.0002
- Subject:
- Public Health and Epidemiology, Public Health
This chapter examines the rise of postmodernism in the second half of the twentieth century and the epistemological challenges it forced upon the core values of scientific positivism. Postmodernism ...
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This chapter examines the rise of postmodernism in the second half of the twentieth century and the epistemological challenges it forced upon the core values of scientific positivism. Postmodernism viewed objectivity as an illusion, a set of images or metanarratives that fragmented both reason and meaning. Applied to medicine, it questioned the “truth” of the physician's reductionist account of illness, including those conclusions drawn from evidence-based medicine (EBM). It also revolted against patient objectification, inferring that the “truth” of an illness is no longer in the physician's objectivist and biomedical account, but in the patient's narrative. This resulted in the rise of complementary and alternative medicine (CAM), a more intuitive and individualized approach to medicine. This new representation of illness involves social, psychological, and cultural components; innovative new discourses on pain, suffering, and empathy; and perceived limitations of the dominant biochemical model.Less
This chapter examines the rise of postmodernism in the second half of the twentieth century and the epistemological challenges it forced upon the core values of scientific positivism. Postmodernism viewed objectivity as an illusion, a set of images or metanarratives that fragmented both reason and meaning. Applied to medicine, it questioned the “truth” of the physician's reductionist account of illness, including those conclusions drawn from evidence-based medicine (EBM). It also revolted against patient objectification, inferring that the “truth” of an illness is no longer in the physician's objectivist and biomedical account, but in the patient's narrative. This resulted in the rise of complementary and alternative medicine (CAM), a more intuitive and individualized approach to medicine. This new representation of illness involves social, psychological, and cultural components; innovative new discourses on pain, suffering, and empathy; and perceived limitations of the dominant biochemical model.
Robyn Bluhm
- Published in print:
- 2017
- Published Online:
- September 2017
- ISBN:
- 9780262035484
- eISBN:
- 9780262341752
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262035484.003.0003
- Subject:
- Psychology, Clinical Psychology
Both evidence-based medicine (EBM) and biological psychiatry aim to improve clinical practice by basing it more firmly on the results of scientific research. In this chapter, however, I show that ...
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Both evidence-based medicine (EBM) and biological psychiatry aim to improve clinical practice by basing it more firmly on the results of scientific research. In this chapter, however, I show that the two approaches have very different views on what kinds of research will improve practice. This is because EBM is a form of medical empiricism – it focuses solely on whether treatments work, while biological psychiatry is a form of medical rationalism – it seeks to understand the causes that give rise to observed clinical outcomes. I argue that EBM’s empiricism is ultimately shortsighted and that it should integrate some of the rationalist concerns with pathophysiology. I then use this analysis to draw some lessons for research based on the NIMH’s new Research Domain Criteria.Less
Both evidence-based medicine (EBM) and biological psychiatry aim to improve clinical practice by basing it more firmly on the results of scientific research. In this chapter, however, I show that the two approaches have very different views on what kinds of research will improve practice. This is because EBM is a form of medical empiricism – it focuses solely on whether treatments work, while biological psychiatry is a form of medical rationalism – it seeks to understand the causes that give rise to observed clinical outcomes. I argue that EBM’s empiricism is ultimately shortsighted and that it should integrate some of the rationalist concerns with pathophysiology. I then use this analysis to draw some lessons for research based on the NIMH’s new Research Domain Criteria.
Colleen Derkatch
- Published in print:
- 2016
- Published Online:
- September 2016
- ISBN:
- 9780226345840
- eISBN:
- 9780226345987
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226345987.003.0005
- Subject:
- History, History of Science, Technology, and Medicine
Central to the question of methodology in research on complementary and alternative medicine (CAM) is the practitioner-patient relationship, the most unambiguously rhetorical element of clinical ...
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Central to the question of methodology in research on complementary and alternative medicine (CAM) is the practitioner-patient relationship, the most unambiguously rhetorical element of clinical medicine. Increased interaction between practitioners and patients in any medical model may have unintended—and unquantifiable—therapeutic effects. Chapter Four examines how research on CAM configures practitioner-patient interaction, particularly in relation to prevalent models of medical practice, including patient-centered care and evidence-based medicine. It argues that studies of CAM posit practitioner-patient interaction as a potential contaminant in trials of acupuncture and chiropractic, wherein attempts to control for placebo effects are, in many cases, attempts to control for interaction effects. Probing these interaction effects can further contribute to new understandings of how practitioner-patient encounters can influence health outcomes. Finally, the chapter examines patient autonomy, closely linked to interaction and central to discourses about CAM both in the texts under study and I medical discourse more generally. The actual extent of autonomy afforded to patients in medical settings, alternative or not, is often illusory, framed within generic and rhetorical processes that necessarily tilt the course of decision-making in particular, and predictably biomedical, directions.Less
Central to the question of methodology in research on complementary and alternative medicine (CAM) is the practitioner-patient relationship, the most unambiguously rhetorical element of clinical medicine. Increased interaction between practitioners and patients in any medical model may have unintended—and unquantifiable—therapeutic effects. Chapter Four examines how research on CAM configures practitioner-patient interaction, particularly in relation to prevalent models of medical practice, including patient-centered care and evidence-based medicine. It argues that studies of CAM posit practitioner-patient interaction as a potential contaminant in trials of acupuncture and chiropractic, wherein attempts to control for placebo effects are, in many cases, attempts to control for interaction effects. Probing these interaction effects can further contribute to new understandings of how practitioner-patient encounters can influence health outcomes. Finally, the chapter examines patient autonomy, closely linked to interaction and central to discourses about CAM both in the texts under study and I medical discourse more generally. The actual extent of autonomy afforded to patients in medical settings, alternative or not, is often illusory, framed within generic and rhetorical processes that necessarily tilt the course of decision-making in particular, and predictably biomedical, directions.
Colleen Derkatch
- Published in print:
- 2016
- Published Online:
- September 2016
- ISBN:
- 9780226345840
- eISBN:
- 9780226345987
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226345987.003.0004
- Subject:
- History, History of Science, Technology, and Medicine
This chapter focuses on scientific method as the key rhetorical topos, or topic, within evidence-based medicine that furnishes lines of argument that researchers adopt to align complementary and ...
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This chapter focuses on scientific method as the key rhetorical topos, or topic, within evidence-based medicine that furnishes lines of argument that researchers adopt to align complementary and alternative medicine (CAM) with scientific boundaries. At the core of debates about CAM is an epistemological debate about how research on CAM ought to be conducted, interpreted, and incorporated into practice because biomedicine’s “gold standard” methodology, the randomized controlled trial (RCT), does not easily accommodate interventions such as acupuncture. The chapter examines how CAM practices fit awkwardly within the RCT format and, turning to studies of experimental articles in rhetoric of science, rhetoric of medicine, and genre theory, investigates how the experimental genre is mobilized in the specific case of biomedical CAM research. It then isolates the concept of efficacy—whether or not a health intervention “works”—as a central organizing principle of biomedical research on CAM. The chapter shows that efficacy can be invoked strategically to draw epistemic and professional boundaries. As this chapter argues, the problem of method in biomedical CAM research is largely a problem of persuasion: the ways that researchers design their studies and report their findings determine which health interventions belong in biomedicine and which do not.Less
This chapter focuses on scientific method as the key rhetorical topos, or topic, within evidence-based medicine that furnishes lines of argument that researchers adopt to align complementary and alternative medicine (CAM) with scientific boundaries. At the core of debates about CAM is an epistemological debate about how research on CAM ought to be conducted, interpreted, and incorporated into practice because biomedicine’s “gold standard” methodology, the randomized controlled trial (RCT), does not easily accommodate interventions such as acupuncture. The chapter examines how CAM practices fit awkwardly within the RCT format and, turning to studies of experimental articles in rhetoric of science, rhetoric of medicine, and genre theory, investigates how the experimental genre is mobilized in the specific case of biomedical CAM research. It then isolates the concept of efficacy—whether or not a health intervention “works”—as a central organizing principle of biomedical research on CAM. The chapter shows that efficacy can be invoked strategically to draw epistemic and professional boundaries. As this chapter argues, the problem of method in biomedical CAM research is largely a problem of persuasion: the ways that researchers design their studies and report their findings determine which health interventions belong in biomedicine and which do not.
Adam D. Reich
- Published in print:
- 2014
- Published Online:
- October 2017
- ISBN:
- 9780691160405
- eISBN:
- 9781400850372
- Item type:
- chapter
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691160405.003.0007
- Subject:
- Sociology, Health, Illness, and Medicine
This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly ...
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This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly rare in the U.S. medical system. On the other hand, GroupCare considered the palliative care program to be consistent with its goal of “appropriate utilization” and likely would not have invested such resources in the program had it not been seen as economically efficient. This chapter shows that the staff at GroupCare tended to believe that through evidence-based medicine, technical savvy, and systems integration, it could make the mission of health care and the market for health care consistent with and supportive of one another. It also considers how GroupCare seemed to have succeeded in taming the market for hospital care and aligning the health of its membership with the economic interests of the organization and the practitioners within it.Less
This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly rare in the U.S. medical system. On the other hand, GroupCare considered the palliative care program to be consistent with its goal of “appropriate utilization” and likely would not have invested such resources in the program had it not been seen as economically efficient. This chapter shows that the staff at GroupCare tended to believe that through evidence-based medicine, technical savvy, and systems integration, it could make the mission of health care and the market for health care consistent with and supportive of one another. It also considers how GroupCare seemed to have succeeded in taming the market for hospital care and aligning the health of its membership with the economic interests of the organization and the practitioners within it.
George Dowswell and Stephen Harrison
- Published in print:
- 2011
- Published Online:
- May 2012
- ISBN:
- 9781847427588
- eISBN:
- 9781447305576
- Item type:
- chapter
- Publisher:
- Policy Press
- DOI:
- 10.1332/policypress/9781847427588.003.0017
- Subject:
- Sociology, Health, Illness, and Medicine
Evidence-based medicine has been a formal component of UK health policy since the early 1990s. This chapter presents a case study that refers to the implementation of clinical guidelines in primary ...
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Evidence-based medicine has been a formal component of UK health policy since the early 1990s. This chapter presents a case study that refers to the implementation of clinical guidelines in primary care. The research upon which the chapter is based was a vehicle for understanding something about the policy, organisational and academic context in which it took place, and the manner in which this subsequently developed. The case study serves as a metaphorical vantage point from which to note that a good deal has in fact changed in relation to the changes in EBM, whose discourse has been partly undermined by a consistent political rhetoric in favour of consumer choice and ‘patient-centred’ health care.Less
Evidence-based medicine has been a formal component of UK health policy since the early 1990s. This chapter presents a case study that refers to the implementation of clinical guidelines in primary care. The research upon which the chapter is based was a vehicle for understanding something about the policy, organisational and academic context in which it took place, and the manner in which this subsequently developed. The case study serves as a metaphorical vantage point from which to note that a good deal has in fact changed in relation to the changes in EBM, whose discourse has been partly undermined by a consistent political rhetoric in favour of consumer choice and ‘patient-centred’ health care.
Holger Wormer
- Published in print:
- 2011
- Published Online:
- May 2016
- ISBN:
- 9780262016032
- eISBN:
- 9780262298957
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262016032.003.0011
- Subject:
- Psychology, Health Psychology
To improve health care journalism, criteria and assessment strategies are needed. This has proven difficult due to the various definitions of quality used by science and journalism. Recommendations ...
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To improve health care journalism, criteria and assessment strategies are needed. This has proven difficult due to the various definitions of quality used by science and journalism. Recommendations are made to integrate these varying perspectives into a usable set of quality criteria. Ranking the quality of health news must be conducted on the basis of consistent criteria. Several strategies are presented to improve evaluation. A two-step model is proposed to increase the quality of investigation and presentation in science journalism. This model is accessible to highly specialized as well as general journalists. An overview is provided of the basic rules in journalistic presentation, and the effects of medical reporting among recipients are discussed. Health reporting in the media and the quality debate concerning direct consumer/patient information (via Internet) is highlighted. Finally, the future role of health care journalism, journalists, and “personal evidence scouts” is discussed in the context of a rapidly changing and fragmented media world.Less
To improve health care journalism, criteria and assessment strategies are needed. This has proven difficult due to the various definitions of quality used by science and journalism. Recommendations are made to integrate these varying perspectives into a usable set of quality criteria. Ranking the quality of health news must be conducted on the basis of consistent criteria. Several strategies are presented to improve evaluation. A two-step model is proposed to increase the quality of investigation and presentation in science journalism. This model is accessible to highly specialized as well as general journalists. An overview is provided of the basic rules in journalistic presentation, and the effects of medical reporting among recipients are discussed. Health reporting in the media and the quality debate concerning direct consumer/patient information (via Internet) is highlighted. Finally, the future role of health care journalism, journalists, and “personal evidence scouts” is discussed in the context of a rapidly changing and fragmented media world.
