Making Evidence Move : Multiplicity and (Im)Mutability

• Evidence-based medicine (EBM) is, in short, the attempt to implement the latest and best evidence to medical practice. One institutional means for this implementation is the function of central agencies such as the Cochrane Collaboration, or (in the UK) NICE, that collect, select, summarize and send off research results in systematic reviews and guidelines. In Sweden, at least three central agencies are involved in this porcess, viz. SBU (The Swedish Council on Technology Assessment in Health Care), the SoS (The National Board of Health and Welfare), and SALAR (The Swedish Association of Local Authorities and Regions). SBU is responsible for the production of systematic reviews and may thus be dubbed the agency of medical evidence and EBM in Sweden. SoS is reponsible for a growing library of national guidelines intended for the regional management of hospitals and clinics. SALAR is the organization - out of the three mentioned here - that is closest to the actors in regions, hospitals and clinics. All three organizations are involved in the compilation and implementation of medical evidence, but whereas SBU is closest to the compilation, SALAR is closest to the implementation. SoS is somewhere in between. This paper asks: what happens to medical evidence as it is packaged and re-packaged by these organizations in documents and other activities? Two methods are used to answer the question: interviews and text studies. By interviewing central actors the explicit views on evidence are highlighted. By studying published reports and guidelines the formal evidence and recommendations can be analyzed. Medical evidence is - and is not - the same thing within these organizations, i.e. in their views and in their products. All actors profess a high regard of evidence, but also hold quite different views on the role and meaning of evidence in good medical care. It has been noted in STS and elsewhere that there is a gap between controlled scientific studies and the messy clinic. Just moving between the three organizations displays the mutability and multiplicity of evidence even before it reaches the clinical mess. These observations are further deepened and elaborated by a corresponding theoretical tension within ANT and STS generally. There are a series of concepts trying to capture the varying degrees of stabilization of knowledge and the role of objects’ immutability and/or malleability in the coordination of practices: from black boxes, to boundary objects, packages and standardizations, into the realm of multiple bodies. When considering this range of theoretical solutions the study of how medical evidence move and mutate between the three organizations in Sweden turns into not only an empirically interesting case. Actors are (often) not naive and provide their own sophisticated theories about the relation between mutability and mobility.

Ämnesord

HUMANIORA  -- Filosofi, etik och religion -- Filosofi (hsv//swe)

HUMANITIES  -- Philosophy, Ethics and Religion -- Philosophy (hsv//eng)

Nyckelord

Evidence-based medicine

multiplicity

SBU

The Swedish National Board of Health and Welfare

Publikations- och innehållstyp

ref (ämneskategori)

kon (ämneskategori)