SOC 7108 Chapter Notes - Chapter 27: Electronic Body Music, Chapter 27, Clinical Trial
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ACCOUNTING FOR EVIDENCE BASED MEDICINE (EBM)
She describes EBM as the demand that clinical practice and health policy and practice be
based on evidence that has critically appraised and systematically reviewed based on their
effectiveness. It is quantitative techniques and procedures founded by individuals at McMaster
during the 1980s who showed a new approach to clinical medicine by showing that
epidemiology can be applied individually to patient care. It was attempting a shift towards a
more science-based approach. She begins with its recognition starting in the 60s onwards for
the purpose of this article.
Critiques of EBM
It continues to be negotiated and broadened its limitations rather than its benefits have
been emphasized and debated in many journals. In this case, the author searched for articles
and journals that provided a comment on EBM (positive or not) followed being categorized in
thematic groups. Thus, the rest of this article seeks to discuss the responses found and the
range of critiques made.
1. Incommensurability of Population Evidence and Individual Patient Needs: many have
argued for their general support for EBM in clinical practice – agreeing that evidence
from randomized controlled trials cannot be read across the clinical managements of
patients in a straightforward way because these types of knowledge are not directly
2. Bias Towards Individualized Interventions: derives from the same problem mentioned
above but has greater implications for public health rather than clinical practice such as
the constraining effects EBM may have on determining what types of interventions are
considered legitimate. EBM practices that are most measurable are based on direct
comparisons between simple treatment and assessment – classical trial tends to be
favoured. The requirement to provide evidence that it is effective before doing the
intervention means that those that are complex by default are less likely to be
supported over time making multiple component interventions lose favor regarding
3. Exclusion of Clinical Skills: focused on the exclusion of the concept known as clinical
expertise – the craft skills required for clinical practice. The debate is surrounded by art
vs. science in regard to clinical medicine. Some suggest that EBM is spurious in nature
trying to regulate what is known as common sense and that it has long been evidence
based. On the contrary, others say that it seeks to reduce automated reading by taking
away patients in favor of scientific knowledge.
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4. Formation of Formulaic Guidelines: formulation and application of these procedures
known as guidelines or protocols. Critiques have primarily focused on the potential
erosion of autonomy represented by these formulas. Regard among implicit
assumptions about acquiring knowledge that underlie the production of these
guidelines and applications that doctors learn along with the quality of patient care.
Others say they limit rather than advance patient choice and are far from ensuring
5. Failure to Consider Patient Views: others are concerned with the voices of patients,
their autonomy and levels of satisfaction among the care they receive. The main
argument here is the putative danger that EBM has due to solely relying on a strict
hierarchy of acceptable forms of evidence, prioritising evidence of effectiveness along
with cost leading to exclusive subjective perceptions including those of actual
individuals who are receiving care.
6. Difficulties in Translating Evidence into Practice: they have expanded on the category
above. It does not seek to question status or value of evidence production and evidence
collection. Most focus on the problem of introducing, disseminating and implementing
evidence within clinical practice where some argue that EBM’s attempts are too
simplistic in terms of behavioural change. They attempt to gather evidence regarding
the use of evidence research within practice and others focus on health policy and
delivering health services.
The Evolution of EBM
The previous section provided a brief overview of the major categories of criticism. Its
limitations have been provided and each has also been accommodated within the means EBM.
She indicates that the criticism has been countered by incorporation. It is an assimilation
response, similar to biomedicine that has dealt with many other contexts of medical traditions.
An example is EBM facilitating the selective incorporation of appropriate validated alternative
traditions into the health care system organization of biomedicine. The evidence-based
approaches have growing value as being legitimate.
Incorporation as a reaction to the responses identified for each category of limitation.
Regarding incommensurability forms of evidence, founders of EBM have argued that these
particular forms of evidence were never meant to be alternatives as in their second edition of
the textbook they demonstrate the need to integrate art and science with other basic sciences
along with the fact that the biases of the selection of interventions towards individual
treatments overlying the elements of the triad presented here. The way it is repositioned as
demonstrated within the figures correctly responds to the complaints that were presented
above in terms of medical judgment being taken away by its initial process of preference and
evidence. The research evidence section however is not really touched. Individuals concerned
with the constraints of professional autonomy and disregard of clinical skill due to standardized
guidelines have responded in the sense that these elements are considered as “cookbook
medicine” needing a bottom-up approach that has the ability to integrate the best external
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