| 'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice. | |
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MedLine Citation:
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PMID: 20367689 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. |
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Authors:
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Ignaas Devisch; Stuart J Murray |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of evaluation in clinical practice Volume: 15 ISSN: 1365-2753 ISO Abbreviation: J Eval Clin Pract Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2010-04-06 Completed Date: 2010-07-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9609066 Medline TA: J Eval Clin Pract Country: England |
Other Details:
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Languages: eng Pagination: 950-4 Citation Subset: IM |
Affiliation:
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Medicine and Ethics, Ghent University, Belgium. ignaas.devisch@ugent.be |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Decision Making Evidence-Based Medicine* Humans Knowledge* Philosophy, Medical* Randomized Controlled Trials as Topic Research Design |
| Comments/Corrections | |
Comment In:
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J Eval Clin Pract. 2009 Dec;15(6):957-9
[PMID:
20367691
]
J Eval Clin Pract. 2009 Dec;15(6):955-6 [PMID: 20367690 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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