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'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice

Author
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Abstract
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.
Keywords
Evidence-Based Medicine (EBM), evidence, critique, deconstruction, Jacques Derrida

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Citation

Please use this url to cite or link to this publication:

MLA
Devisch, Ignaas, and Stuart J. Murray. “‘We Hold These Truths to Be Self-Evident’: Deconstructing ‘evidence-Based’ Medical Practice.” JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 15, no. 6, 2009, pp. 950–64, doi:10.1111/j.1365-2753.2009.01232.x.
APA
Devisch, I., & Murray, S. J. (2009). “We hold these truths to be self-evident”: deconstructing “evidence-based” medical practice. JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 15(6), 950–964. https://doi.org/10.1111/j.1365-2753.2009.01232.x
Chicago author-date
Devisch, Ignaas, and Stuart J Murray. 2009. “‘We Hold These Truths to Be Self-Evident’: Deconstructing ‘evidence-Based’ Medical Practice.” JOURNAL OF EVALUATION IN CLINICAL PRACTICE 15 (6): 950–64. https://doi.org/10.1111/j.1365-2753.2009.01232.x.
Chicago author-date (all authors)
Devisch, Ignaas, and Stuart J Murray. 2009. “‘We Hold These Truths to Be Self-Evident’: Deconstructing ‘evidence-Based’ Medical Practice.” JOURNAL OF EVALUATION IN CLINICAL PRACTICE 15 (6): 950–964. doi:10.1111/j.1365-2753.2009.01232.x.
Vancouver
1.
Devisch I, Murray SJ. “We hold these truths to be self-evident”: deconstructing “evidence-based” medical practice. JOURNAL OF EVALUATION IN CLINICAL PRACTICE. 2009;15(6):950–64.
IEEE
[1]
I. Devisch and S. J. Murray, “‘We hold these truths to be self-evident’: deconstructing ‘evidence-based’ medical practice,” JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 15, no. 6, pp. 950–964, 2009.
@article{817083,
  abstract     = {{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.}},
  author       = {{Devisch, Ignaas and Murray, Stuart J}},
  issn         = {{1356-1294}},
  journal      = {{JOURNAL OF EVALUATION IN CLINICAL PRACTICE}},
  keywords     = {{Evidence-Based Medicine (EBM),evidence,critique,deconstruction,Jacques Derrida}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{950--964}},
  title        = {{'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice}},
  url          = {{http://doi.org/10.1111/j.1365-2753.2009.01232.x}},
  volume       = {{15}},
  year         = {{2009}},
}

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