Accounting for EBM: Notions of evidence in medicine
Abstract
This paper takes as a focus of anthropological enquiry the set of techniques and practices for the appraisal and clinical application of research evidence that has become known as evidence-based medicine (EBM) (or, more recently, evidence-based health care). It first delineates and classifies the criticisms of EBM emerging from within the health professions. It then charts the evolution of EBM in responding to these criticisms and uncovers its character as a pedagogical innovation aimed at transforming clinical practice. It identifies EBM as an indeterminate and malleable range of techniques and practices characterised not by particular kinds of methodological rigour, but by the pursuit of a new approach to medical knowledge and authority. It situates this characterisation within a contemporaneous political and economic climate of declining trust and growing accountability. This analysis provides a basis from which to consider the notions of evidence implicit in EBM itself and also in the qualitative social sciences, including anthropology, which not only critique but also contribute to these notions themselves. Finally, the paper considers possible future trajectories for EBM with regard to the incorporation of cultural and structural dimensions of health and the inclusion of qualitative material in the evidence base.
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One powerful critique of EBM is that there is often incommensurability between population evidence concluded from RCTs and individual patient needs, such that evidence of the effects of interventions in populations cannot be straightforwardly read across to the clinical management of individual patients.
“One powerful critique of EBM is that there is often incommensurability of population evidence (concluded from RCTs) and individual patient needs, that 'evidence . . . of the effects of interventions in populations cannot be straightforwardly 'read across' to the clinical management of individual patients'.$^{4}$^{6}”
From Contemporary Conversations between Ayurveda and Biomedicine (2014) · cites this paper as Lambert 2006
Dahanukar's review aimed to compile data generated through research activity using modern scientific approaches and innovative scientific tools in the last five-year period, i.e., 1994-8.
“Analysing work done over a five-year period, she presented a review 'that aims to compile data generated through the research activity using modern scientific approaches and innovative scientific tools in the last five-year period, i.e., 1994-8'.$^{2}$^{1}”
From Contemporary Conversations between Ayurveda and Biomedicine (2014) · cites this paper as [21]
Underlying the difficulty in translating population evidence to individual patient management is the notion that these forms of knowledge are essentially incommensurate.
“Lambert extends this to state that, 'Underlying this difficulty in translation is the notion that these forms of knowledge are essentially incommensurate'.$^{4}$^{7}”
From Contemporary Conversations between Ayurveda and Biomedicine (2014) · cites this paper as Lambert 2006
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Sexual behaviour in context: a global perspective
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- Authors
- Lambert, H.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Lambert, Helen
- ORCID
- Lambert, Helen
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2006-06
- Volume
- 62
- Issue
- 11
- Pages
- 2633-2645
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W1971190521
- Cited by
- 320
- References
- 4
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 19 · 2023: 15 · 2022: 16 · 2021: 13 · 2020: 26 · 2019: 16 · 2018: 19 · 2017: 16 · 2016: 23 · 2015: 13 · 2014: 23 · 2013: 17 · 2012: 18
- FWCI
- 22.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Keywords
- evidence-based medicine, evidence-based care, medical knowledge, medical authority, clinical practice, educational innovation, trust in medicine, accountability, qualitative evidence, cultural factors in health, medical anthropology
- MeSH terms
- Anthropology, Decision Making, Delivery of Health Care, United Kingdom, Humans, Models, Theoretical, Morals, Social Responsibility, Evidence-Based Medicine
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