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Evidence-based practice (EBP) has been launched, spread, and established in social work in Sweden in the last decade. Today, impact studies and 'what works' are the recommended approaches, and medical ways to understand and examine social problems thus are prioritised over the broad social science perspectives on which social work rests. This development has culminated in an institutionalised system called 'state governing of knowledge'. We analyse the Swedish EBP movement as an 'epistemic community', directing our attention to the ways in which evidence is constructed and proclaimed valid for policy and practice. Empirically, we build on documents from various actors involved in EBP in social work and on results from our ongoing research on documentary practices in the social services. We identify four strategies that key actors use within the Swedish EBP community to contest, redefine, and constrain the academic knowledge base of social work: efforts to (1) construct a (state) knowledge bureaucracy, (2) standardise social work research, (3) exclude important aspects of social work expertise, and (4) govern social work practice. All four strategies are supported by 'improvement rhetoric' that aims at justifying the project.

BackgroundAccording to the World Health Organization (WHO) the cost of adverse drug reactions (ADRs) in the general population is high and under-reporting by health professionals is a well-recognized problem. Another way to increase ADR reporting is to let the consumers themselves report directly to the authorities. In Sweden it is mandatory for prescribers to report serious ADRs to the Medical Products Agency (MPA), but there are no such regulations for consumers. The non-profit and independent organization Consumer Association for Medicines and Health, KILEN has launched the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. This study aimed to analyze these consumer reports.MethodsAll reports submitted from January 2002 to April 2009 to an open web site in Sweden where anyone could report their experience with the use of pharmaceuticals were analyzed with focus on common psychiatric side effects related to antidepressant usage. More than one ADR for a specific drug could be reported.ResultsIn total 665 reports were made during the period. 442 reports concerned antidepressant medications and the individual antidepressant reports represented 2392 ADRs and 878 (37%) of these were psychiatric ADRs. 75% of the individual reports concerned serotonin-reuptake inhibitor (SSRI) and the rest serotonin-norepinephrine reuptake inhibitor (SNRI). Women reported more antidepressant psychiatric ADRs (71%) compared to men (24%). More potentially serious psychiatric ADRs were frequently reported to KILEN and withdrawal symptoms during discontinuation were also reported as a common issue.ConclusionsThe present study indicates that consumer reports may contribute with important information regarding more serious psychiatric ADRs following antidepressant treatment. Consumer reporting may be considered a complement to traditional ADR reporting.