Fundamental shortcomings of evidence-based medicine.
The development of any scientific theory has a certain logic. Bruno Latour formulated a theory, describing the development of science and technology. Outcomes of science are not guided by nature or "the truth", but by a complex negotiation. It starts with ideas, which follow paths of publications and assessment. Then they are either rejected or accepted. Analysing the development of evidence-based medicine with Latour's theory, we find two fundamental problems. First, EBM tends to standardise moral considerations. Second, EBM standardises the patient, since test populations are usually composed homogeneously. Presumptions concerning methods and morals are slid into the EBM-methodology during its development. With Latour we should say, that the conceptions of the standard patient and standard morals have been delegated to this methodology. They are carried out strictly, and this causes the discomfort with practitioners and scientists within EBM. A solution should be sought for in redesigning trials, in a less morally charged fashion, and concerning less standardised patients.
Valkenburg
Govert
G
University of Twente, Enschede, The Netherlands.
Achterhuis
Hans
H
Nijhof
André
A
D019317:Evidence-Based Medicine / Q000592:standards*; D008962:Models, Theoretical; D010686:Philosophy, Medical; D012586:Science; D013672:Technology