A neo-pragmatist view of evidence-based medicine (EBM)

Article Sidebar

Requires Subscription or Fee PDF (USD 25)
Published: Jan 19, 2015
DOI: https://doi.org/10.5750/ijpcm.v4i2.458
Keywords:
Evidence-based medicine EBM philosophy Rorty neo-pragmatism pragmatism Dewey.

Main Article Content

Brian Walsh
Director, Driving Doctors Ltd., Auckland, New Zealand

Abstract

 In contrast to previous papers in which Evidence Based Medicine (EBM) is faulted for not checking its conceptual structure against philosophy, this paper excuses EBM. Philosophy was based on essentialism, objectivity, and the Cartesian divide between the mind inside and the world outside. Knowledge was a representation of reality, inspected for accuracy by the retina, and polished from time to time.  Some post-Kantian philosophers have abandoned this set-up, regarding it as just one image, accompanied by pretensions to a superior understanding of truth, the mind and knowledge. EBM, in this paper, is forgiven for not trying to square off with this traditional image, rather noticing that people are suffering, seeking a method of coping with illness, and asking, “Does it work?”  This paper, drawing on the thought of Richard Rorty, views EBM as having capitalized on the development of such contingencies as statistics and the world wide web, and having provided another description of patients, in terms of “the evidence”, rather than focusing on discovering what patients are “really like”. In its search for knowledge, EBM has changed the definition of “objectivity” to agreement among qualified people. Even so, clinical research, although “useful”, does tend to hark back to ascertaining what really is the case, whatever that means. It is hard to see what EBM can do about this since most patients seek this kind of bio-medical knowledge when consulting a doctor (although some consult alternative health practitioners, who often use a different model).

Article Details

Issue
Vol. 4 No. 2 (2014)
Section
Regular Articles

References

. Miles, A., Loughlin, M,. & Polychronis, A. (2007). ‘Medicine and evidence: Knowledge and action in clinical practice’. Journal of Evaluation in Clinical Practice, v. 13 (4), pp. 481-503.

. Popper, K. (2002). Conjectures and Refutations: the growth of scientific knowledge. New York: Rutledge, Taylor & Francis Group.

. Djulbegovic, B., Guyatt, G.H., & Ashcroft, R.E. (2009). ‘Epistemologic inquiries in evidence-based medicine.’ Cancer Control, v. 16, pp.158-168.

. Voparil, C. J. and Bernstein, R., eds. (2010). The Rorty Reader. Chichester, United Kingdom: Wiley-Blackwell.

. Grade Working Group. (2004). ‘Grading quality of evidence and strength of recommendations.’ BMJ, v. 328, 1490. doi: 10.1136/bmj.328.7454.1490.

. Loughlin, M. V. (2009). ‘The search for substance: a quest for the indentity conditions of evidence-based medicine and some comments on Djulbegovic, B., Guyatt, G. & Ashcroft, R. E. (2009) Cancer Control, 16, 158-168.’ Journal of Evaluation in Clinical Practice, v. 15, pp. 910-914.

. Rorty, R. (1979). Philosophy and the Mirror of Nature. Princeton, New Jersey: Princeton University Press.

. Rorty, R. (2010). ‘Philosophy as a transitional genre.’ In: The Rorty Reader. (eds. C. J. Voparil and R. J. Bernstein), pp. 473-488. Chichester, United Kingdom: Wiley-Blackwell.

. The Evidence-Based Medicine Working Group. (1992). ‘Evidence-based Medicine: A new approach to teaching the practice of medicine.’ JAMA, v. 268 (17), pp. 2420-2425.

. Walsh, B. H. (2012). A post-structuralist view of evidence-based medicine. www.librarything.com/work/12707045.

. Loughlin, M. (2007). ‘Style, substance, newspeak “and all that”: A commentary on Murray et al. (2007) and an open challenge to Goldacre and other “offended” apologists for EBM’. Journal of Evaluation in Clinical Practice, v.13 (4), pp. 517-521.

. Voparil, C. J. (2010). ‘General introduction.’ In: The Rorty Reader. (eds. C J. Voparil and R. Bernstein), pp.1-51. Chichester, United Kingdom: Wiley-Blackwell.

. Rorty, R. (1989). Contingency, irony and solidarity. New York: Cambridge University Press.

. Bassler, D., Busse, J.W., Karanicolas, P.J., & Guyatt, G.H. (2008). ‘Evidence-based medicine targets the individual patient. Part 1: How clinicians can use study results to determine optimal individual care’. ACP Journal Club, v.148, pp. JC4-2.

. Bassler, D., Karanicolas, P.J., Busse, J.W., & Guyatt, G.H. (2008). ‘Evidence-based medicine targets the individual patient. Part 2. Guides and tools for individual decision-making’. ACP Journal Club, v.149, pp. JC1-2.

. Gadamer, H.-G. (2005). Truth and Method, 2nd ed. New York: Continuum International Publishing Company.

. Heidegger, M. (1962). Being and Time. (J. Macquarrie & E. Robinson, Trans.) New York, Hagerstown, San Francisco, London: Harper and Row, Publishers. (Original work published 1927), pp. 1-208.