The Subjectivity of Objectivity: The Social, Cultural and Political Shaping of Evidence-Based Medicine

Abstract

Most critiques of evidence-based medicine (EBM) focus on the scientific shortcomings of the technique. Social scientists are more likely to criticize EBM for it ideological biases. In this chapter, we provide a different critique. Our critique does not focus on the inconsistencies and practical problems of data collection. We find EBM to be flawed, not because it fails to be scientific, but because - like all science - it imports the biases of researchers and clinicians. In this paper we explore three sources of these biases: the structural arrangement of clinical research, the cultural ideas that shape research questions and research design, and the political goals that influence how evidence is presented in the public arena. Our evidence - drawn from separate studies of 1) the funding of pharmaceutical research, 2) the use of research data to support government policy on home birth in the Netherlands, and 3) the use of previous research on adverse events in The Institute of Medicine's report on Medical Error - shows how bias finds its way into the scientific literature. If medicine wants to be truly evidence based, it has to take these structural, cultural and political biases into account when designing policies and practices.

Keywords: evidence based medicine, evidence, medical research, bias, pharmaceuticals, drug regulation, pharmaceutical regulation, conflict of interest, obstetrics, home birth, midwivery, medical error

JEL Classification: I1, I18, Z00