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Postivisim Resurgent
The epistemological foundations of evidence-based medicine
Kevin White
Senior Lecturer, Department of Sociology, Australian National University, Canberra, ACT
Evan Willis
School of Social Sciences, La Trobe University, VIC
Abstract
The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterize as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing.
This paper lays out the claims of EMB - its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine - and analyses them in the framework of sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicines, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and sociology of medicine.
The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.
Keywords
sociology of medical knowledge, professions, evidence-based medicine
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