Contesting that a debate on evidence-based health care has taken place, this article charts three paths to the future: continuing avoidance of debate by proponents of evidence-based medicine (EBM); conflict, which the EBM movement courts and critics have espoused, and dialogue. The last portal allows for integration, which would end the disagreement between EBM and its critics and make a debate unnecessary. In search of integration, I sketch a bridge whose construction requires not compromise but a win- win approach. The (...) bridge is a medicine of meaning (MOM). Consolidating multiple pillars of evidence to unify questions that are not necessarily the same for protagonists and critics of EBM, a MOM contends that the purpose or meaning of medicine is always healing and helping, and each party finds meaning in medicine by contributing to this common purpose in its own distinctive way. (shrink)

Mediating the meaning of evidence through epistemological diversity Nursing's disciplinary recognition of ‘multiple ways of knowing’ reflects an epistemological diversity that supports nursing praxis. Nursing as praxis offers a conceptual way to explore what it is about the interface of practice, knowledge and evidence in nursing that distinguishes us as a discipline. I suggest that the relationship between evidence and knowledge is defined and mediated by the same epistemological diversity that supports nursing as praxis. Just as the meaning and truth‐value (...) of evidence is evaluated from within the body of existing disciplinary knowledge, new evidence may prompt an evaluation of the meaning and truth‐value of extant nursing knowledge. Nursing practice that relies on scientific evidence as a singular basis of practice knowledge is susceptible to exploitation by the diverse agendas operating within an ideology of evidence‐based practice and the healthcare system. Mediating the meaning of evidence for nursing practice through acknowledgement of the diverse epistemologies that underpin nursing knowledge will contribute to a disciplinary‐specific definition of what constitutes evidence for nursing, and will better direct how evidence is integrated into a disciplinary body of knowledge. (shrink)

The question of how we apply knowledge from biomedical science to medical and public health practice has been the subject of heated debates about generalizability and related concepts, such as applicability and inductive inference. In this essay, I interpret the term from the perspective of two causal models: determinism and indeterminism. I suggest that theories of generalizability can be formulated on the basis of both models and take the form of testable but unverifiable hypotheses, an attribute that is common to (...) all scientific theories. Nonetheless, there is one noteworthy difference between the two models: determinism allows one to rationalize a decision to treat a certain kind of patient but only indirectly a decision to treat any particular patient, whereas indeterminism accommodates both types of decisions. (shrink)