Tarnished Gold by Steve Hickey and Hilary Roberts: EBM as An Avatar of Modern Medicine

Wyer, Peter C.; Silva, Suzana Alves

doi:10.5750/ejpch.v1i1.643

Cited by 4 publications

(5 citation statements)

References 70 publications

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“…However, the EBM manifesto [11] was particularly effective in generating substantial attention and controversy [62]. This, together with EBM's emphasis on information from clinical trials and on hierarchies of clinical research evidence, not to mention the distinct inclination towards 'empire building' on the part of EBM founders that would become more evident over time [17], rapidly led to a tendency in the literature to equate the term 'evidence-based medicine' with the entire interface between clinical research and healthcare, including the clinical research enterprise itself [25,26,63].…”

Section: Evidence-based Medicine (Ebm): the Ultimate Confoundermentioning

confidence: 99%

Person Centered Healthcare and Clinical Research: The Necessity of an Evolutionary Hierarchy of Knowing and Doing

Wyer¹,

Loughlin²

2020

EJPCH

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Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients’ risks being ignored.Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterize more or less developed thinking and judgment on the part of the particular practitioner.

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Section: Evidence-based Medicine (Ebm): the Ultimate Confoundermentioning

confidence: 99%

Person Centered Healthcare and Clinical Research: The Necessity of an Evolutionary Hierarchy of Knowing and Doing

Wyer¹,

Loughlin²

2020

EJPCH

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“…TG and her co‐authors are not alone in reflecting a relatively boundless understanding of the scope of EBM, as evidenced by a recent book review on EBM and standardization [14]. We have previously identified an analogous tendency among both declared friends and enemies of EBM [15–18]. Of these, ‘Tarnished Gold’ [19] is a thinly masked criticism of population‐based immunization policy, in favour of Vitamin C as a cure all for polio and other viral diseases [18].…”

Section: The Enigma Of ‘Ebm Pan‐critique’mentioning

confidence: 99%

“…We have previously identified an analogous tendency among both declared friends and enemies of EBM [15–18]. Of these, ‘Tarnished Gold’ [19] is a thinly masked criticism of population‐based immunization policy, in favour of Vitamin C as a cure all for polio and other viral diseases [18]. The authors frame their argument as a broad‐based refutation of the methods of contemporary clinical research, as well as of the Cochrane Collaboration's methodology of systematic reviews, all of which they equate with EBM.…”

Section: The Enigma Of ‘Ebm Pan‐critique’mentioning

confidence: 99%

‘All theKing's horses …’: the problematical fate of born‐again evidence‐based medicine: commentary onGreenhalgh,T.,Snow,R.,Ryan,S.,Rees,S., andSalisbury,H. (2015) six ‘biases’ against patients and carers in evidence‐based medicine.BioMedCentralMedicine, 13:200

Wyer

Silva

2015

Evaluation Clinical Practice

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The phrase ‘evidence-based medicine (EBM)’ is being used by both EBM advocates and adversaries to broadly denote the production and use of clinical research throughout the healthcare system. Recently, this trend was joined by a call for a general expansion and rebirth of EBM to encompass a diverse range of healthcare activities otherwise corresponding to person-centred care. The call asserts that EBM is to blame for anti-patient biases within clinical practice and in policy and public health domains. Effective critique of either EBM or of the healthcare system requires that EBM itself be properly identified as a research literacy movement that grew out of clinical epidemiology of the 1970’s and 1980’s. We demonstrate the ineffectiveness of inappropriately targeted critiques of healthcare under the banner of born-again EBM.We identify the strengths and weaknesses of EBM as an educational movement drawing on the concept of literacy associated with the Brazilian educator Paolo Freire. We consider the relationship of EBM to clinical epidemiology and conclude that it cannot fruitfully divorce itself from the latter.We briefly consider existing precedents for philosophically sound conceptual platforms for advocacy of person-centred healthcare and broad based critique of the healthcare system including relationship-centred care. We conclude that traditional EBM, as a framework for research literacy training of both clinicians and policy makers, must continue to play a subsidiary role within an expanding patient-centred healthcare system and that advocacy efforts on behalf of patient voice and engagement are best pursued unencumbered by subsidiary agendas.

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“…An alternative, expanded, definition of EBM, uses the term to denote virtually the entire interface between the clinical research enterprise and the healthcare system [4,18]. Within this minimally bounded vision of EBM, which, depending upon one's predilections might be called either "Everything Bad in Medicine" or "Everything Better in Medicine", commentators have held EBM responsible for the breakdown in integrity of research information [15,19]. The latter perspective consistently leads to unfocused discussions about the problems of the healthcare system [16].…”

Section: Introductionmentioning

confidence: 99%

The Tree of Wisdom: Maintaining epistemological health within an (emerging) evidence-free environment

Wyer¹

2018

EJPCH

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Mounting concerns regarding the corruption of the clinical research enterprise by the pharmaceutical industry, as well as demonstrations of the inappropriateness of traditional research designs and consequent clinical guidelines to direct application to patient care, have led to challenges to the integrity of the evidence-based medicine (EBM) movement. However, the emerging crisis of confidence in clinical research should be seen as a threat to the viability of the entire healthcare system, not simply to EBM. Efforts of the EBM movement to represent itself as the brokers and mediators of the clinical research-healthcare interface are impediments to a full appreciation of the dilemma. Recognizing the implications of contrasting epistemological stances regarding the relationship of clinical research findings to healthcare policy and practice is essential to maximizing the value of research to the healthcare system. A synergy between empiricism-rationalism epistemologies, particularly conspicuous within the EBM movement, is identified as an important philosophical barrier to achievement of this goal. The notion of an evolutionary hierarchy of knowledge and wisdom is proposed as a vehicle to demonstrate a social constructivist alternative to a dualistic epistemology. Contrasting examples of social constructivist and empiricist-rationalist descriptions of integration of research with healthcare practice are provided for purposes of illustration.

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Tarnished Gold by Steve Hickey and Hilary Roberts: EBM as An Avatar of Modern Medicine

Cited by 4 publications

References 70 publications

Person Centered Healthcare and Clinical Research: The Necessity of an Evolutionary Hierarchy of Knowing and Doing

Person Centered Healthcare and Clinical Research: The Necessity of an Evolutionary Hierarchy of Knowing and Doing

‘All theKing's horses …’: the problematical fate of born‐again evidence‐based medicine: commentary onGreenhalgh,T.,Snow,R.,Ryan,S.,Rees,S., andSalisbury,H. (2015) six ‘biases’ against patients and carers in evidence‐based medicine.BioMedCentralMedicine, 13:200

The Tree of Wisdom: Maintaining epistemological health within an (emerging) evidence-free environment

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