A post-structuralist view of evidence-based medicine (EBM): what EBM contributes to philosophy

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Published: Jun 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i2.62

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Brian Walsh
Division of Health Sciences, University of Otago, Dunedin, New Zealand
Grant Gillett
Division of Health Sciences, University of Otago, Dunedin, New Zealand

Abstract

Background: Evidence-based medicine (EBM) has been faulted by numerous philosophers and doctors who have complained about lack of theory, lack of evidence, narrowness and hegemony. Aims: We provide a more positive viewpoint from the writings of Gilles Deleuze a post-structuralist philosopher, then we aim to explore what EBM contributes to philosophy.Methods: We draw on the Deleuzian concepts of desire, difference and multiplicity and his teaching that no academic discipline can police another and that philosophy can be enriched by people with a fresh approach and different conceptual tools.  We draw on biostatisticians, doctors and philosophers to contribute to a philosophy of medicine in a Deleuzian way.Results: We see the pioneers as energised by desire, producing a different product (EBM) to solve the problems such as  variation in practice.  We argue that the usual complaints about EBM are part of a turf war between nomadic science and State science and are unrealistic.  The debates about EBM have stretched the minds of doctors and philosophers to plumb a deeper understanding of such issues in philosophy of medicine as evidence, variation, and authority.  In epistemology, we explain that EBM has precipitated a crisis.Conclusions: We present EBM as an action philosophy which immersed itself in the problems of medicine and health services management and did not wait to check everything it was doing against the mirror world of philosophy.  We believe we have documented advances in our understanding of some medical philosophical issues, much of the paper centring around the difficult issue of the general and the particular.

Article Details

Issue
Vol. 1 No. 2 (2011): June
Section
Regular Articles

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