The Evidence-Based Medicine Condition: A Report on Uses and Abuses

• This article is not questioning the validity or even the usefulness of evidence-based medicine (EBM) technical developments. Rather, the author is engaging with the conceptual framework within which EBM has been developed, interpreted and presented. Thus, this article explores the sociopolitical conditions that underlie characterizing EBM as paradigm and the implications of this label on practicing it in the developed as well as developing world. As medicine does not belong to pure sciences, it is believed here that the claim of paradigmatic characteristic is implanted to fulfil authoritative symbolic function rather than expressing a presumed revolutionary and radical change. This authoritative function, which enables EBM to transcend the clinical epidemiology it established on, could articulate three axes: the demise of welfare state, the postmodernist assault on the classical notions of truth and certainty, and the crisis of the medical professions. One prominent evidence that supports our proposal is the dynamicity of the movement and its capacity to “engulf” everything in its way including pseudoscience. It is noted that a major consequence of assigning EBM as paradigm is to give it a legitimized and rationalized potentiality for abuse by the profit-oriented medicalpharmaceutical complex. Another major impact is on the developing countries, which because they follow the educational and practical systems of medicine in the West, are in more positive attitude to both the drug companies and to new fashions. Beyond these issues, it is argued in the current paper that the claim of paradigm attains efficiently the control and power functions of EBM via achieving “ totalizing ” discourse creating norms for the consciousness and moral identity of the clinician. In short, it is via the paradigmatic characterization EBM engages in reasserting its hegemony in the face of a variety of challenges, and at the same time, assimilates as much as possible the sources of such challenges. It is assumed that the susceptibility of EBM for corruption will continue unless the disguising power of EBM is dismantled via humanist and medical critiques.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

Abuse; Assimilation; Colonization; Developing world; Authority; Evidence-based medicine/ practice; Knowledge/power; Paradigm; Pharmaceutical industry; Randomized control trials

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